§ 2.54 p.m.
§ LORD RAGLAN
My Lords, I beg to move that this Bill be now read a second time. As many of your Lordships know, this subject is not new to your Lordships' House. In 1936, a Bill to legalise voluntary euthanasia was moved by the late Lord Ponsonby of Shulebrede. In 1950 my noble friend Lord Chorley (who to his great regret cannot be here to-day) moved a Motion calling attention to the need for legalising euthanasia. I shall not refer to those debates to-day except to acknowledge with deep gratitude the efforts of both those noble Lords and of those who supported them at the time, including my noble friend Lord 1144 Huntingdon, who I am glad to see will be speaking to-day.
I think that I have good reason to believe that opinion generally has become so favourable to a change in the law that the time is ripe, not to bring a Motion to test your Lordships' opinion but to introduce another Bill incorporating changes in the proposed formalities and safeguards, which I think were rightly criticised in the previous Bill, and which I, with some confidence, hope your Lordships will think a sound basis for legislation. When my noble friend Lord Longford was criticising the Abortion Bill he made a prophecy that it would be "euthanasia next". In fact, it was quite a safe prophecy to make, because this Bill, as I see it, is one in line with recent measures, such as the Suicide Act and others, which betoken a change of attitude in our society towards the freedom of the individual.
§ THE EARL OF LONGFORD
My Lord, if I may interrupt the noble Lord, it may have been absolutely safe at the time, but it was treated as completely ridiculous. I do not know whether that is within the recollection of the noble Lord.
§ LORD RAGLAN
There is nowadays less inclination to demand that the State should legislate in areas of private conscience and behaviour: on the contrary, there is a growing demand for the repeal or modification of existing legislation where it is thought to be unwarrantably restrictive of private choice. In fact, it may seem in some respects surprising that voluntary euthanasia has not already become legal, but the chief reason is, I believe, that those who most wish for it, the old and the very infirm, are, by their very nature, not in a position to mount an energetic and articulate campaign. Those who suffer and die slowly may not have much to say for themselves; and death itself is the most private experience of all. So it is left to their relatives and friends to ponder the matter and to wonder, too, whether they will have to suffer in the same way. One American journalist, who had watched his sister die, wrote that,spending up to 22 hours a day for almost two months, in the hospital room of someone you love, witnessing not the prolongation of life but the long-drawing-out of dying, leaves you looking at such things quite differently to the way you ever had before.1145 I do not think I can adequately describe the feelings of the people who have written or spoken to me, and I will not quote them. But it may seem paradoxical that the science of medicine, by the very competence of its resuscitatory techniques, has increased many people's fear of a vegetable existence beyond their normal span. I know that there are objections to this Bill. They are moral and ethical, religious, medical and practical. But I am bound to say to your Lordships that since the Bill was published I have been constantly encouraged and heartened by the sheer number of people, strangers as well as friends, who have wished the Bill well; and the letters I have received have been overwhelmingly—ten to one—in favour of the Bill.
It is a fact that most dying people cling to life. But the purpose of this Bill is to give to others, though they be the minority, the freedom not to live on if they do not or would not choose to. It has not always been considered that one's life is one's own. It used to be thought to be the property of the State, and to some extent it still is the case. Conscription into the Armed Services is one example. But, since the 1961 Suicide Act, to kill oneself is no longer a crime, a felony, and one is free to attempt it without fear of prosecution. So it is not a question of whether people should be given the right to kill themselves—this they already have; it is whether that liberty should be extended, under certain safeguards, to those dying people who are in no position to help themselves and would like to have their lives terminated by the kindly action of medication administered by the agency of another.
Voluntary euthanasia has a very ancient history on the battlefield. Many a dying soldier has asked his friend to kill him. The circumstances in which euthanasia is wished and prayed for, in hospital or the home, are of course quite different from those of the battlefield. Modern methods can keep people alive, sometimes it seems almost indefinitely, and they can lie in a twilight between life and death for long periods and in great discomfort, misery and world weariness, severely maimed in body and perhaps in mind, and the will to live long gone. Their bodies and their personalities may have disintegrated to such a degree that life has become a meaningless burden to 1146 them and they look forward to the relief which death can bring them.
Some people think that the process of dying should be and can be spiritually ennobling and even quite a cheerful experience. I am very grateful to the noble Lord, Lord Amulree, himself a distinguished geriatrician, for taking me to see the wonderful work of Dr. Cicely Saunders at Streatham. It might be said that if everyone could spend his last days in such surroundings there would be no need for this Bill. But not only would that leave out of account the fact that, out of the approximately 680,000 people who die in this country every year, only a tiny fraction can go into such an institution—though with money and education that situation might in time be changed—it leaves out those who do not wish to eke out their lives in this way. Indeed, about half the 680,000 I have mentioned die in their home or a relative's home, and it seems very understandable that they should wish to. I myself should like to die in my own home if I could.
Dr. Saunders's objection to voluntary euthanasia is that it is:a flat denial of God's power and wisdom, and above all, of His love".I would put it the other way round: that her loving care and zealous attention are the manifestation of her personal faith, a reconciliation between it and the facts of living and dying. My belief, and I hope it is that of your Lordships, is that others should be allowed to be free, not only to form but to act upon their own interpretation of those facts, because in so doing what they ask for is only between themselves and their Maker, or if they are agnostic they believe it will affect only them. I hope very much that the kind of work which Dr. Saunders and others are doing will be followed, at least as far as more normal staffing ratios will allow, and especially as, with the modern break-up of family units, the old and the dying simply do not get the family affection and attention which they used to be able to demand.
But the provisions in the Bill go hand in hand with improvements in care and treatment, and I think that no one should seek to deny them to those who want 1147 them on the grounds that they are unethical or immoral. We all have the right to live as long as we can. But in the end, as we all have to die, surely it is right that, having filled life with as much as luck, medical science and our own abilities and opportunities have enabled us to do, we should all be allowed to die at such a time and in such a way as we would choose and not just in the way that someone else has chosen for us. I am in no position to pronounce upon the theology involved but I would point out that pain and suffering used to be declared God's punishment for sins, and that the more one suffered in this world the better place one would be likely to obtain in the next.
It may seem hardly believable now that the introduction of anæsthetics was opposed, as indeed it was, for just those reasons. I think that before the days of anæsthetics such an idea would indeed have been a great consolation to those in pain—to believe that they were being prepared for the Great Beyond—but this doctrine has now very largely been abandoned, I think, and doctors of all creeds now give large doses of sedatives, even though by doing so they may be shortening a person's life. Many doctors maintain a distinction between shortening a life and actively terminating it, but the principle has become established that it is better in terminal cases that a human being die than that he be allowed to suffer great pain. I think it very important in any discussion upon voluntary euthanasia that the general acceptance of this principle should be borne in mind.
So now I come to the doctors' part in this matter, which of course is very important indeed. I am informed that the British Medical Association are opposed to the Bill. I think that I can not inaccurately sum up what I understand to be their opinion in four words: "Leave it to us". That it is left to them, and that most of them shoulder the responsibility, is exemplified in the reply by Dr. Donald Gould in a B.B.C. television programme on the 7th of this month. When referring to such a thing as the withdrawal of antibiotics leading to death, he said:This has been done—it has been done throughout history, I imagine; that the doctor does, at a time when his sensibility tells him it is the right thing to do, help some un 1148 fortunate suffering creature over the edge and, you know, out of the condition of distress.This is borne out by a poll conducted by National Opinion Polls in January, 1965, on a sample of 1,000 doctors: 76.2 per cent. agreed (I quote from the question) thatsome medical men do in fact help their patients over the last hurdle in order to save them unnecessary suffering, even if that involves some curtailment of life".Though it does not generally seem to be admitted by those who oppose voluntary euthanasia, it is easier for the wealthy to choose a doctor or nursing home to minister to their every want, including their desire for a peaceful death. This is no allegation that hospital doctors are less humane than others; such an allegation would of course be absurd. It is simply that it is usually the case that, especially in National Health hospitals, they have to have very strict rules and, what is more, those who themselves believe in euthanasia can be reported by those who do not. So, apart from the usual luck of the draw as to who happens to be your doctor, what we have at the present time is a better opportunity for the rich than for the poor. Again, it is a criticism by those doctors who advocate the legislation of voluntary euthanasia that many doctors who do administer euthanasia do so too slowly and too late, and that the enthusiasm of physicians for modern methods of resuscitation blurs their judgment. Doctors are taught to look upon these things as technical problems and not as individual human problems. So it becomes the medical ethic and medical ambition to keep people alive for as long as possible.
It has been said that doctors can, and should, be taught a different attitude towards their patients, and as I intimated earlier I am sure that much could be done in education aimed at providing better terminal care. I believe that there would be general agreement on that point. But this still would mean that the doctor would be in a constant dilemma of reconciling, on the one hand, the fundamental objective of his calling—which is the preservation of life, with something that is subjective, the prevention of needless suffering. So far from making legislation unnecessary, the contrary is the case, because under this Bill a doctor would be able to obtain guidance from the patient as to how these 1149 rival considerations might be balanced in the patient's case.
I find it hardly surprising that, of the doctors who were questioned in the survey I have mentioned, no fewer than 36.4 per cent., said that if voluntary euthanasia were made legal they would be prepared to administer it, because it would let them off the hook by bringing the patient's wishes into the calculation. I pointed out earlier that in one respect doctors have already achieved this reconciliation between the objective and the subjective, between the technical and the philosophical, and that is in the relief of great pain. The patient cries out, and a dose is given; then next time perhaps the dose is a bigger one, until such a large dose has to be given that it proves fatal. So the patient has asked for relief and the doctor, in his compassion has given it, even unto death. This is established practice and therefore I do not think many doctors will disagree with Clause 8 of the Bill, which has been inserted for the removal of doubt and the endorsement of law.
But the doctor's dilemma—and it is an awesome and lonely responsibility—comes principally where there is not the presence of great pain to provide an an obvious guide as to what to do. I will not give instances, but there are irremediable terminal conditions which can be accompanied by great mental suffering. It is in conditions of this kind that a person may feel that he is no longer a person, but just existing, perhaps a travesty of himself. Good doctors are aware of this feeling in the patient, but as the law stands there is nothing they can do. In such a situation, the declaration in the Schedule to the Bill would give them ethical guidance as to what the patient wished, and the doctor would be enabled to accede to that wish.
I will now take your Lordships through the Bill as shortly as I can. Clause 1 makes it lawful for a physician to give enthanasia subject to the provisions in the Bill. Clause 2 says that a declaration will come into force 30 days after being made. This avoids the death-bed formalities which were so criticised in the case of the other Bill. Unless revoked, the declaration will remain in force for three years. After three years it automatically lapses, unless it is re-executed within the 12 months preceding its expiry date, when it will remain 1150 in force for life. Thus it is assumed that if a person has twice signed such a declaration he really means it.
Clause 3 makes it clear that a declaration can be revoked at any time. Clauses 4 and 5 are straightforward, and give the duties, rights and protection of physicians and nurses. Clause 6 makes it an offence wilfully to conceal, destroy, falsify or forge a declaration. Clause 7 says that no policy of insurance which has been in force for 12 months shall be vitiated. Clause 8 I have already mentioned. The first part entitles a patient to whatever quantity of drugs may be required to keep him free from pain. The second part deals with severe stress which cannot be relieved by the ordinary pain-killing drugs, and would make the law clear on a point on which I am advised it is not clear at the moment. Clause 9 gives the power to the Secretary of State for Social Services to make regulations under the Act. In the Schedule will be found the proposed declaration, which I think is self-explanatory. I am perfectly prepared, of course, to be told, that a better form of words could be found, or that modification to the existing words should be made. I am open to all suggestions, and should welcome them. In substance, however, I hope your Lordships will be reasonably well satisfied that the declaration says what it means.
Some of your Lordships may have visions of friends or relations clamouring that some poor old aunt should put her name to a declaration, so I hope your Lordships will notice that the testification will be by two people of recognised stature, to be approved by the Secretary of State, and that they will have to declare that they know of no pressure being brought on the declarant. This is a much better safeguard than the law at present requires when a will is made. Nevertheless, I think I should say that a declaration bears not the smallest resemblance to a death warrant; it only indicates to a doctor a declarant's wishes, and it is only at the discretion of two doctors that euthanasia would be administered. I must emphasise that there is nothing in this Bill which makes anybody do anything, except perhaps in Clause 8 which gives the patient in certain circumstances a right to drugs.
My Lords, it has been alleged that the provisions in the Bill would destroy people's confidence in their doctors, and 1151 that they are inconsistent with the doctor/patient relationship. As I have already said, this Bill would for several reasons be a practical help to both patients and doctors. But, in any case, not only would no one sign a declaration unless he wished to, but no one would sign a declaration unless he had full confidence in his doctor. The confidence would not be that the doctor would, in his case, try to keep him alive for as long as possible, but that the doctor would end life when it became unbearable. Therefore, far from destroying the doctor/patient relationship it would undoubtedly help to generate more confidence and trust than exists at the moment, at any rate in some cases.
Lastly, my Lords I have heard it said that the Bill if enacted would cheapen life and would lead to an attitude in which life was not held to be so precious as it is now. But we are now slowly emerging from past eras when life really has been held cheaply; when battle, murder and sudden death have been the common experience of mankind. At no time in history has life been held so valuable as it is to-day. And, due to medical science, at no time have people been able to look forward to so long a life as they can now. I think it is highly significant that for the first time, up and down the country, we are talking not only about the length of life, but about the quality of it, too. This Bill is a liberal and humanitarian measure for those who treasure for themselves the quality of life as much as its quantity. It is because I believe that this balance between quantity and quality is one which people should be free to strike for themselves that I commend the Bill to your Lordships, and beg to move that it be now read a second time,
§ Moved, That the Bill be now read 2ª. —(Lord Raglan.)
§ 3.20 p.m.
§ THE EARL OF CORK AND ORRERY
My Lords, I beg to move, as an Amendment to the Motion for the Second Reading, to leave out the word "now" and insert at the end "this day six months". I find myself in a position of some strangeness, for I am about to urge the rejection of a Bill while approving, or at any rate sympathising with, its aims. Indeed, few. I think, would fail to sym- 1152 pathise, for the motive that informs it is compassion, and the deep and genuine compassion of its sponsor has been made perfectly clear beyond all doubt by the noble Lord's own speech.
I oppose the Bill because I believe it to be a bad Bill, inadequately thought out, ill-drafted and riddled with loopholes and ambiguities of the most dangerous kind; and above all because it fails in what it chiefly ought to do and what its supporters claim it does do. It provides no reliable safeguards for the the patient. For some patients it provides no safeguards—none at all—and a few it even exposes to the risk of manslaughter and conceivably, in extreme cases, of murder. All this I say without meaning to imply either disapproval or approval of the idea behind the Bill. Debate about the rights and wrongs of euthanasia as a principle I leave to other noble Lords who will follow me in the debate.
Euthanasia, in the Concise Oxford Dictionary definition, is:Gentle and easy death; the bringing about of this, especially in case of incurable and painful disease".For the purpose of the Bill, therefore, it is the bringing about of gentle and easy death. The Bill defines it in Clause 1(2) as "the painless inducement of death". But an inducement is something you offer to somebody to persuade him to do something, and painless death can be brought about with a hammer or a hand grenade. So it is not, to put it mildly, a very good definition. Incidentally, it contains the only mention of pain in the whole of the Bill. Perhaps noble Lords will suspect me of triviality in picking on so small a thing, but the point is this: what kind of Bill are we to expect from a draftsman or draftsmen capable of so grotesque a definition of the very thing that forms both the subject and the object of the Bill? Will anyone blame me for reading on with a suspicious eye?
I began to be suspicious of this Bill at a very early stage. My attention was directed, as I suspect was that of most of those who have read the Bill, to what are described, and have been referred to by the noble Lord, Lord Raglan, as the safeguards, and of which I have said in fact there are none. I find, to my astonishment, that there are only two safeguards properly so-called, and they operate only 1153 with the declaration itself that the person or future sufferer has to make. I refer to the two subsections of Clause 6 which impose appropriately strong penalties for misdemeanours in connection with the declaration itself. From that point onwards such safeguards as there be are for the protection of the doctor or the nurse, while the patient is on his own. This is so far removed from the obvious intention of the Bill that I must be at some pains to explain why I believe it to be true, but I think I shall have little difficulty in convincing your Lordships that I am right if you will follow me in considering what might happen in one or two particular cases.
To begin with, a person—not yet necessarily a patient but a person—signs the declaration set out in the Schedule, or something substantially in that form. For the moment the only part of what he has actually signed that we need pay attention to is that part contained in some of the words in paragraph A:If I should at any time suffer from a serious physical illness or impairment reasonably thought in my case to be incurable and expected to cause me severe distress … I request the administration of euthanasia.In these words he has signed, if not an authority, at least an indemnification for his own manslaughter, if not murder.
But before I explain that highly provocative statement perhaps noble Lords would glance at the form of attestation in that last paragraph of the Schedule on page 4. This has to be signed by two witnesses under appropriate safeguards which the noble Lord has mentioned—safeguards, that is, concerning the reliability and standing of the witnesses—and they will be deemed to have committed an offence under the Perjury Act 1911 if they wilfully put their signatures to a statement they know to be false. In point of fact they have to sign six statements, five of which could almost certainly never be quoted against a signatory witness in evidence of perjury. Those five are:The declarant"—that is, the prospective candidate for euthanasia—… appeared to appreciatethe significance of the declaration that he signed.We do not know of any pressure being brought on him …we believe it is made by his own wish.1154So far as we are aware, we are entitled to attest this declaration anddo not stand to benefit by the death of the declarant."So far as we are aware", "the declarent appeared", "we believe"—how could you ever hope to pin anyone down on such negative non-committal testimony as that? It leaves only ore statement genuinely amenable to sanction of the law, namely:We testify that the above-named declarant signed this declaration in our presence.But suppose he did not sign. Then his life might depend on the word of any two people who are prepared to testify that he… was unable to write but assented to this declaration in our presence, and appeared to appreciate its significance.I said the Bill was full of loopholes. These words provide a loophole big enough for murder.
Now let us return to the declarant. All we know about him at present is that he is over the age of majority and that he has signed the declaration. A couple of years or so later he re-executes it, and unless he revokes it, it remains in force for the rest of his life. The years, go by and he falls ill. More, he becomes a "qualified patient" as defined in Clause 1(2). To this status of qualified patient he is appointed by the action of two physicians (one being of consultant status) who certify in writing that the patient appears to them to be suffering from a serious physical illness reasonably thought in his case to be incurable and expected to cause him severe distress. This condition would be met if these two doctors, either singly or together, were to certify that he was suffering from, say, chronic bronchitis or some other severely distressing complaint that they though: could reasonably be described in his case as incurable. Interpretation of "serious illness" and "severe distress" is left entirely to their discretion.
More time goes by. The patient falls on evil days. He loses his wife, his livelihood, his home. Life holds no solace for him any more and he gives way to despair. He succumbs to an onset of his "irremediable condition". To the doctor who attends him—a strange doctor, possibly, whom he has never seen before—he presents his declaration and certificate or certificates and asks for euthanasia. The doctor considers his own duties and rights 1155 under Clause 4(1) of the Bill and finds that all that is required of him is that he shall satisfy himself that the patient is mentally responsible and that… the declaration and all steps proposed to be taken under it accord with the patient's wishes.There is no difficulty about that, and the doctor is perfectly free to decide at his own sole discretion and without reference to anyone whether or not to kill the man. Suicide by proxy—is that what you intend, my Lords? I do not know; but that is what you would be legalising if you passed this Bill as it now stands. Is it right to put such responsibility on to the shoulders of a doctor? Five doctors are to speak in this debate, and I look forward to hearing what they have to say.
Let us suppose a different sort of case. Imagine that in his early days a man has had a morbid fear of cancer and has made his declaration with that possibility in mind and no other. Many years later he is badly injured in a motor accident, perhaps irrevocably paralysed; perhaps he loses both his legs. He is taken to hospital in a coma of unpredictable duration. There is no difficulty here of certifying him as a qualified patient. Somebody comes forward with his declaration that he has signed years before and the request for euthanasia is complete. Since he is not mentally responsible, the declaration exactly covers his present condition. He is even asked in paragraph B of the declaration that no attempt shall be made to restore him to consciousness, and there is no one who knows that he never intended his declaration to operate in such a situation as this. Again, the responsibility lies with the doctor; but this time he has no means of knowing whether the lethal needle will be an instrument of longed-for mercy or of legal manslaughter.
There are endless permutations of the possibility of error and also of abuse which I think it is hardly necessary for me to indicate. However, may I briefly mention just one other conceivable contingency. Once more we have a "qualified patient", but he is conscious and mentally responsible and has no intention of giving the go-ahead for his own extinction as required by paragraph A of the declaration. The physician (who knows of the declaration but has no thought of 1156 implementing it) prescribes some drug. A nurse in error administers an overdose and the patient dies. The doctor learns what has happened. If he wishes to cover up for the nurse he has only to declare that she was acting correctly on his instructions, and the patient's own declaration is his or her warrant, for no further signature or authority is required of the patient. His spoken request to a single doctor is enough, since in paragraph C of the declaration the patient has said that:… any request I may make concerning action that may be taken or withheld in connection with this declaration will be made without further formalities.And who but the doctor can ever know, once he is dead, that he never made any such request?
Perhaps your Lordships begin to see why I say that such safeguards as the Bill contains operate only in favour of the doctor or the nurse and not in favour of the patient. I take it as clear that such safeguards are of literally vital importance and will certainly have to be in the Bill. But what do we find? We find in Clause 9(1) that the making of them is to be the responsibility of the Secretary of State for Social Services, who is to make regulations for, among other things,the prescribing of any matters which he may think fit to prescribe for the purposes of this Act.If a Bill is to be drafted in that sort of way, we might almost as well leave out everything after Clause 1(1) and tell the Secretary of State to write the rest of it himself.
What else do we find under paragraph A of the declaration? We find that it is permissible to ask for death in case of a serious physical impairment reasonably thought to be incurable and likely to render the sufferer incapable of rational existence. Many of us who are neither priests nor doctors must have seen this happen. We know only too well—I am sure the noble Lord, Lord Amulree, as a geriatrician will confirm this—that age itself brings on many a condition that is bound to end, unless life ends first, in rendering the patient incapable of rational existence. Hardening of the arteries is perhaps the standard example.
We touch here upon the dilemma of the modern doctor who has learned how to keep us alive without curing us of our 1157 complaints. Here, if he is prepared to accept it, is a possible escape from his dilemma, for he will be allowed at the patient's request to put an end to his life, not merely when he is in extremis but when he, the doctor, sees senile degeneration inevitably coming on. But would the doctor ever be sure that he was really doing it for the benefit of the patient, rather than for the benefit of those whom the patient loved and to whom he wished not to be a burden? Again, suicide by proxy, the responsibility being handed over by the patient to the doctor.
And what of the old who have already passed beyond the power of rational existence? Having once signed the declaration perhaps years before, they could all be quietly put away. "And why not?" perhaps I am asked. In which case, I reply only with further questions: How do you know if the patient is suffering, and how much? I would not ask this question if I thought that the decision would always be left to the genuinely sole discretion of the doctor. But think of the pressures that would be put upon him by loving relations! Has anyone who signs such a request when in full health and in his right mind any idea of what life will be like for him if ever he loses the power of rational thought? Can you be certain that senile dementia in any particular case means agony? Surely, the most that the doctor can do is to give the sufferer the benefit of the doubt. What is the benefit of the doubt—life or death? Even leaving moral considerations on one side, ought we not to ponder long and deeply before making a law to legalise the putting away of the helpless old?
I could go on dissecting in this way subsection by subsection, but I doubt whether your Lordships would applaud me, and I desist. It may well be said that I have not yet made out a case for the rejection of the Bill. I may be told that it would be nut right by debate and Amendment in Committee. I say, No; and for two reasons. First, such a process with a Bill such as this would produce virtually a new Bill, and a botched-up one at that. Far better that it be taken away now and replaced in time by a new one evolved after wise deliberation and far, far deeper thought. Secondly, I question whether a Bill— 1158 any Bill—is the best vehicle in which to bring so high a matter as this before Parliament for the first time. The noble Lord, Lord Chorley, did not think so when he initiated his debate on euthanasia 18 years ago.
§ LORD RAGLAN
My Lords, may I interrupt the noble Lord? It is the second time this matter has been before Parliament. A Bill was introduced in 1936.
§ THE EARL OF CORK AND ORRERY
My Lords, I think this is the first time that a Bill has been before this House. But surely the noble Lord, Lord Chorley, was right in taking the view that the way to such a measure should be paved by means of dispassionate debate in your Lordships' House: by a debate that had no chance, as this one has, of issuing in a Bill, but which, by exploring the subject in both width and depth, should provide a ground without which it would be unwise to proceed to legislation. It is my personal hope, therefore, that this debate may perform that function and no more; and, in the hope that your Lordships may approve my Amendment, I am more than ready to pay my tribute to the noble Lord, Lord Raglan, for performing a most important public service in initiating it.
Eighteen years is a long time, and much has changed. On the one hand, the whole climate of opinion has changed in many ways, and it may well emerge that the general attitude to euthanasia has become more liberal. Supporters of the Bill may take comfort from that. On the other hand, medical science has made advances and the ability of doctors to reduce suffering has increased, perhaps sufficiently to eliminate the need or even the justification for such a Bill. I do not know how the balance between these two factors will be found to lie, but perhaps this debate may help us to find out.
I do not think, however, that the introducing of the Bill was a mistake. We know now, and with this debate the knowledge becomes public, that euthanasia is an issue that the public conscience has to face. From now on, it is permanently in the air. No longer is it a topic of academic debate, but a hard fact of life of our time, to take or put aside. If we refuse to accept it this 1159 afternoon, we shall not have abolished it. It will come back; I am quite sure of that. We shall only have pushed it back. But I hope that by that time, when it does come back, the debate will have spread out far beyond this Chamber, into the Press, into the correspondence columns, and into all places in which such matters as these are properly and authoritatively discussed.
A Second Reading debate is not simply a discussion of a printed Bill. It is discussion of the import and intentions of the Bill, and of its ultimate effects. In such a case as this it is concerned also with morality, humanity, religion and metaphysics. We ought also to be sure that we have got the logic of the matter right, for if we have not we may be setting in motion a logical train the implications of which we shall find horrifying. For example, if we accept the desirability of euthanasia for "qualified patients" as defined by this Bill, I foresee no difficulty at all in making out a rational case for its acceptance on behalf of the psychotic criminal, and thereafter for the acceptance of non-voluntary euthanasia for the congenitally insane. I know that this is a misuse of the words "non-voluntary" and "voluntary", but I take it from the title of the Bill, and I am sure that I shall not be misunderstood. Who knows where we might be asked to go from there along the path that was followed in Nazi Germany?
We must bear in mind that, as I remarked earlier, we are being asked, among other things, to approve of suicide by proxy, which is a somewhat subtler notion than might at first appear. A "qualified patient", as defined in this Bill, might easily find himself in a position to administer euthanasia to himself—indeed, some do. Why then, in such a case, should we empower a doctor to do it for him? If a man is deterred by some scruple from taking his own life, what are we to think of him if he finds it possible to overcome that scruple by shifting the responsibility on to someone else? We are bound to think less of him, are we not, since a scruple is a matter of conscience: so why should we extend this mercy to him yet deny it to one who has no such scruple and to whom life has become, from quite 1160 other causes, a drab monotony of bitterness and despair?
My Lords, you will have had enough of my unanswered questions. It is time for me to give way, and give others a chance, if they feel so inclined, to answer them. I have restricted my remarks to some of the dangers that I see implicit in this premature and, as I believe, woolly-minded Bill. Others will attack it on these more philosophical grounds that I mentioned a minute ago. I hope that these two lines of attack—separate but converging—and perhaps others that may be joined on to them, will together be powerful enough to persuade your Lordships to support me in saying to the noble Lord, Lord Raglan, "Take it away, my Lord; take it away!" I beg to move.
§ Moved, as an Amendment to the Motion, That the Bill be now read 2ª, to leave out ("now") and insert ("this day six months").—(The Earl of Cork and Orrery.)
§ 3.43 p.m.
§ LORD NEWTON
My Lords, at the instance of the noble Lord, Lord Raglan—and I am sure the whole House will agree with me that he is warmly to be congratulated on the way and the manner in which he introduced his Bill—we are once again debating a social question with a high moral content, and most of us, I suppose, can do no more than express our own personal opinions. Neither my Party nor, so far as I know, any other political Party has, thank goodness! an official policy on euthanasia, and the fact that I am speaking from this Box means no more than that, since somebody has to speak from this Box, the duty has fallen upon me. I noticed in yesterday's Daily Telegraph that the columnist "Peterborough" prophesied and deplored that the Minister of State, the noble Baroness, Lady Serota, and I would steer a neutral course. Much though I should enjoy steering a course with the noble Baroness, I must point out that "Peterborough" did not consult me, at any rate, before making his prediction. In fact, I am not going to steer a neutral course and I never intended to, but I should say that the views that I am going to express are entirely my own and nobody else's, unless they happen to agree with me.
1161 The main purpose of this Bill—and I put it simply and starkly, leaving out for the moment the procedures to be gone through and the safeguards to be provided—is to make it lawful for one person to kill another if the second person wants to be killed and is apparently suffering from an incurable physical disease. This raises a deep issue of principle; but superficially it looks like a straightforward question. Actually it is not straightforward. There is an even deeper question of principle and it is this: should it ever, in any circumstances, be lawful for one man to kill another at his request? My answer is "No". To me the idea is abhorrent and immoral. That is sufficient reason for me to oppose the Second Reading of this Bill and support the Amendment of my noble friend Lord Cork and Orrery, as I do; but I recognise that because I am expressing what philosophers might call an "absolute ethical judgment", some of your Lordships may feel that it is not good enough for me just to stand upon it.
Apart from the basic principle, to my mind some of the details of the Bill are immoral in themselves, even if one accepts the principle. The Bill ignores both the occasional fallibility of medical diagnosis and the wonders which medical science performs and which, one can confidently hope, it will increasingly perform. But I am thinking particularly of Clause 2 of the Bill which provides that if a healthy young person, initially aged, say, 21, makes two declarations within three years, that will hold good for the rest of his life unless he remembers to revoke it. But if, in the fullness of time and years, that formerly young and healthy person becomes gravely ill—perhaps paralysed both in speech and in limbs—is it to be believed that it will be possible to ascertain with complete certainty what his wishes as to euthanasia really are? My Lords, I do not think so. Surely it must be within the experience of all of us that whatever view an individual may express in his youth, the nearer he gets to death the longer he wants to live—unless he is suffering great pain, and I will come on to that in a moment.
I have said that to the question "Should it ever, in any circumstances, be lawful for one man to kill another at his request?" my answer is "No". The answer of the noble Lord, Lord 1162 Raglan, and his supporters must, on the other hand, be "Yes", and so for them an awkward consequence automatically follows. Since their purpose is to permit release from suffering and all its attendant misery, it is illogical of them to limit the release to release from physical suffering only. One way of describing this Bill is to call it the legalising, in certain circumstances, of suicide at one remove—or suicide by proxy, as my noble friend described it; the taking of one's own life by the hand of another. Fear of painful illness or death is one reason why people commit suicide; but they also commit it because they are afraid of going mad, or afraid of being a burden on those nearest and dearest to them, or because they have lost those nearest and dearest to them, or because they are bankrupt, or because they fear prosecution for a serious offence, and so on. In other words, people kill themselves because, for a variety of reasons, life has become intolerable and they no longer have anything to hope for.
Now, my Lords, until quite recently—as the noble Lord, Lord Raglan, reminded us in his speech—attempted suicide was a crime. But when Parliament decided to change the law, Parliament did not make suicide or attempted suicide legal for specified people only; it made it legal for all. The Bill before us would legalise what I have called "suicide at one remove" and my noble friend, Lord Cork and Orrery, called "suicide by proxy" for specified people only, and not for all. Why this discrimination? I very much hope that in the course of this debate those who support this Bill will give us the explanation. The answer may be that they are frightened of going too far and, that, if they did go too far, the Bill would not stand a chance of reaching the Statute Book. But it seems to me that in the application of a moral principle one should be logical and consistent, and if being logical and consistent leads to embarrassment or absurdity then one should re-think the principle. However, we have in this Bill the limitation of physical suffering—the limitation of the "qualified patient" as defined in Clause 1(2).
This brings me to the point that, given this limitation, the Bill is unnecessary. It is unnecessary because of the practice 1163 of doctors as broadly described in Clause 8, a practice which the Bill seeks to remove from legal doubt. I thankfully know—surely we must all know from our own experiences and the noble Lord, Lord Raglan admitted it—that doctors relieve pain even though life may thereby be shortened. Doctors exercise their discretion, and I am sure that they should continue to be trusted to exercise it. I am equally sure that it would be a mistake for Parliament to lay down a code of medical practice, as Clause 8 seeks to do, for abuses would then creep in. When one knows what one has to get round, it is easier to do so. For example, every lawyer knows that it can sometimes be important that one person should die before another, even though it is only just before.
Being opposed to the Bill in principle, I will make only brief reference to its details. I suspect, subject to what the Minister of State may tell us, that if the Bill gets a Second Reading it will need re-drafting from top to bottom. I was glad to know that my noble friend Lord Cork thinks so too. If I may give one illustration, who on earth is a "mentally responsible patient", the phrase used in Clause 4? This phrase is not defined in the definition clause and, so far as I know, it does not occur in any Statute, though I am open to correction. I recognise, as does my noble friend Lord Cork, that the safeguards in the Bill are well-intentioned, but, like my noble friend, I doubt whether they are adequate; and he gave good reasons for his justification of that fear. I do not even believe that the safeguards, such as they are, are adequately spelt out in the Bill—which again, I suppose, goes to the question of drafting.
Under Clause 6, if my interpretation is right, a spouse, or son or daughter is liable to imprisonment for life for concealing or destroying a declaration requesting euthanasia, even though that declaration may have been made fifty years previously. How barbarous can zealots become? I feel, without wishing to give offence to the noble Lord, Lord Raglan, the the prescribed declaration in the Schedule is too ludicrous to deserve much comment. The most extraordinary part about it is that it gives an invitation to a healthy young adult above the age of 1164 majority, whatever that age may be, to say:I wish it to be understood that I have confidence in the good faith of my relatives and physicians, and fear degeneration and indignity far more than I fear premature death.Even if a young adult is prepared to testify to that when still a young adult, how on earth can he or anyone else know that when he reaches the age when euthanasia may have to be employed he will still have confidence in the good faith of his relatives and physicians? It does not seem to be sensible.
The worst bit of the Bill is the omnibus Clause 9, which places on the shoulders of the unfortunate Secretary of State the duty of regulating lawful homicide. That is not a duty which I should like to assume, and I do not think that it is a duty which should be entrusted to any Minister in any Government. This is a thoroughly bad Bill, and I hope that your Lordships will refuse to give it a Second Reading.
§ 3.55 p.m.
§ LORD AMULREE
My Lords, we all have a great deal of sympathy with the object of the Bill which has been introduced by the noble Lord, Lord Raglan. We all want to see the relief of suffering, sick patients made comfortable, and the situation that people who are going to die should be able to die in peace and dignity; but I am doubtful that the method commended by the noble Lord will enable these purposes to be carried out.
I should like to touch upon the question of the use of drugs in relief of pain. We are told that certain people are suffering great pain because they have some kind of incurable disease and are not being given the appropriate drugs. This may have been the case at one time, when the only drugs available were opium and morphia. These were dreaded by patients and their relatives. When given in large quantities over a long period of time, they led to distressing deterioration of personality, which was unpleasant for the relatives and distressing for the patients. Surely the situation has now changed a great deal. Many more drugs are now available and do not have this distressing effect.
Before the days of the National Health Service—from about 1926 to 1928—I was 1165 closely associated with a hospital in the North of London which was called, "A Home for the Dying". There were about 50 patients there who were nearly all dying of cancer. A first-class matron was in charge—though she had a good deal of trouble in getting nursing staff—and there was a very good doctor looking after the patients. I have never been in such a contented hospital and, in a curious way, in such a happy hospital. That is probably still the case to-day, although I gave up my connection with the hospital when the National Health Service came in.
In coping with pain we have to concentrate upon the training of our doctors, and we must carry out more research into methods of dealing with pain. One can do a great deal in the training of young doctors. At present, because the curriculum is so full and crowded, there is not a great deal of time for the teaching of ethical and moral matters. Nevertheless, a certain amount is being done, it has been well received, and has had encouraging results. It is far easier to train young doctors in hospital wards when they are carrying out their first resident appointments than when they are at medical schools. There is a body with which I am now associated, called the London Medical Group. That is a voluntary organisation run partly by the Church and partly by doctors. The object is to give lectures to students—medical students, divinity students, nursing students, social worker students—in the evenings upon these moral and ethical problems. About 50 lectures a year are given under the auspices of this body, and they are very well attended and popular. This shows that there is a great wish among the students and young doctors to learn what to do in cases such as those we are talking about now which do not come under the normal medical curriculum.
The second question that I should like to put is: what exactly is the demand for euthanasia? That is something which we have never really been told. For seventeen years I was in charge of a geriatric department consisting of 120 beds in one of the London hospitals. So far as I remember, not one patient of mine ever said, "Will you please put me out of my misery or pain"; and I think the nurses would have told me if that 1166 had ever been said to them. There was a good deal of pressure from some of the patients' relatives to get that done, but that is quite a different matter. The relatives were feeling upset and were feeling —I do not mean this unkindly—sentimental about their relatives, and they put that suggestion to one.
I am sorry, my Lords, but I remember that there was one patient who did ask me that question, and that was an old lady of over 90 who was comfortably and happily married for 62 years. Her husband died and she rather let herself go. She came into hospital with nothing physically wrong with her, but she said that there was no point in her living and asked whether we could help her to die. That is the only case I know, but it would not come under this Bill because the patient was not in sufficient mental or physical stress to qualify. The old have a fear of death. I do not mean that they are frightened of dying, but they have a fear of death. They would rather welcome the act of dying, provided that it was not encouraged by anybody. They do not want to feel that they are being encouraged to die, but when the moment comes for them to die they face it with a great deal of calmness and serenity. I know that may sound a rather difficult psychological paradox to put to your Lordships, but that has been my experience and one can speak only from what one has seen.
One must be careful not to prolong the act of dying, and people must therefore be encouraged to use sense and sensibility in the care and treatment of unconscious or semi-demented patients. Indeed, you can permit sins of omission there, rather than sins of commission. I do not use the word "sins" in any pejorative sense, but I think your Lordships will know what I mean. I was at one time a member of a small committee working under the right reverend Prelate the Bishop of Durham (who I am pleased to see is to speak to-day) and we went into the problems of decisions about life and death. I shall not now go into that aspect this afternoon, and will leave the points raised then to the right reverend Prelate.
One has been told on more than one occasion (I do not say that this comes into the Bill) that if people can have euthanasia made available it will relieve 1167 a great burden that falls on their relatives and on society. That is entirely false reasoning. If the care of the sick relative is too much for the rest of the relatives, and if it is said to be throwing too much of a burden on society, then surely the right thing to do is to encourage the building of more accommodation to take more of these people. I know I shall be told that we cannot afford to do that at the present time, but even less can we afford to drop our moral standards by encouraging the belief that these people should be killed.
One is told, too, that if more of these homes are established it will not be possible to find staff to serve in them. There is a certain truth in that, but I know of various places where incurables are taken care of, and although such places have trouble in getting staff they manage to do it by having a good matron to look for staff and to encourage them. The atmosphere of a place has a bearing on whether or not the getting of staff is easy. It seems to me important that the confidence of the patients in doctors and hospitals should be maintained. We do not want the patient to feel that the man with a syringe is going to be a killer, and not someone who is going to relieve pain. We do not want it to get known, as might quite well happen, that certain hospitals are places at which people can get good euthanasia if they apply, because that will surely mean that patients will not go there when they do not want euthanasia. So there is going to be a great deal of mental and moral difficulty there.
My Lords, the best definition of the purpose of a doctor occurs in that short French saying:"Guérir quelquefois, soulager souvent, consoler toujours".It is the "consoler toujours", which I want to stress now, but I do not think that is going to come in by some system of voluntary euthanasia. Therefore, if we go to a Division I propose to support the Amendment and not the Bill itself.
§ 4.8 p.m.
§ BARONESS SEROTA
My Lords, we have all listened with close interest and attention to the discussion which has so far taken place on the Bill, whose twin aims are to legalise the administration of euthanasia and to enable persons to make 1168 and revoke an advance declaration in favour of euthanasia. This Bill raises the fundamental issue—a highly controversial one whether considered from the ethical, social, legal, or medical point of view—of whether a new approach to euthanasia can be justified, and whether such a practice could be safely codified into law. Considerable arguments both moral and practical, for and against, have already been deployed by the four noble Lords who have spoken so far; and I have no doubt that they will be followed up with equal vigour as the debate proceeds. Some will argue that any individual who is suffering severely from an incurable condition should have the right voluntarily to ask for his life to be ended in a peaceful and dignified way, rather than have to endure continuing pain or to face what may become no more than a distressing, irrational or purposeless existence. Others will maintain that any taking of human life, however well intentioned the motives, is indistinguishable from the act of murder and that it would be wrong in any circumstances to legalise such conduct.
The noble Lord, Lord Raglan, reminded us that these matters were debated in your Lordships' House in 1936 on a Second Reading debate, and again in 1950 on a general Motion. In both debates those in favour of voluntary euthanasia and those against it spoke with matching fervour from their respective points of view. It was clearly predictable that, notwithstanding the increased permissiveness in our society to-day, the long debate we are to have on the Second Reading of this Bill would continue to reflect those differences with undiminished vehemence. This is essentially a matter of conscience on which, as with all other issues of this kind, the Government think it right, so far as the main principle of the Bill is concerned, to leave the verdict to the free vote of individual Members of the House.
I must, however, ask all noble Lords to examine very carefully indeed the administrative provisions which the Bill involves, with which the Government must clearly be closely concerned even at Second Reading stage. Even among those noble Lords who give their support in principle to the arguments in favour of voluntary euthanasia, there must, I believe, be many who will entertain grave 1169 doubts whether the burdens of responsibilities and duties which this Bill would require my right honourable friend the Secretary of State for Social Services to lay upon doctors, nurses and other hospital workers would be an acceptable one. This point has already been made by both the noble Lord, Lord Newton, and the noble Earl, Lord Cork and Orrery. At present, some doctors may, in the course of their treatment, for example, to relieve pain, take steps which may hasten the patient's death. Such action is the result of a positive decision made by the individual doctor in accordance with his clinical judgment and the dictates of his own conscience.
What this Bill appears to do—and I must confess that I find it not at all clear on this point—is to require my right honourable friend to appoint hospital doctors (and hospital doctors only, as I read the Bill) who are willing to administer euthanasia and who alone would be authorised to administer it to those patients who have asked for it. I should point out here that it is not only full-time National Health Service doctors who could be appointed under the Bill as drafted, but also those whose practice was only part-time in the National Health Service and also doctors who practise wholly or partly in private hospitals. If my reading of the Bill is right, the limiting of appointment under the Bill to hospital doctors in itself could give rise to difficulties in that a family doctor, although clearly a physician as defined in Clause 1, would not be able, even if he was willing, to administer euthanasia to one of his own patients who wished to die at home. He would instead have to call in an authorised hospital doctor to do this for him, or refer his patient to an appropriate hospital. I would also point out that the Bill permits an authorised hospital doctor to delegate his duty of administering euthanasia to a nurse.
There would be a further difficulty for authorised doctors in that they would have to be sure that the patient knew what he was doing when he made his request for euthanasia; that, as noble Lords have already pointed out, he was under no external pressure from, for example, his relatives; that the witnesses to his declaration really did not stand to benefit from his death; and that he had not changed his mind. I shall deal 1170 more fully with some of these points a little later. Moreover, we believe that the medical and nursing professions in general would oppose the introduction of legalised voluntary euthanasia, as the noble Lord, Lord Amulree, indicated in his speech; so we might be faced with the practical difficulty of finding sufficient doctors and nurses up and down the country who were in fact willing to undertake the duty of administering euthanasia. These are formidable practical difficulties, and because of them my right honourable friend is not willing to accept the regulation-making duty conferred by Clause 9(1), and all that this involves.
I should like now briefly to turn to some more detailed points of administration in the Bill. Although the Explanatory Memorandum to the Bill refers tothe administration of euthanasia in certain specified circumstances one or more of which has eventuated",the Bill itself does not make clear at what stage of a patient's illness he would become qualified for euthanasia. A patient may be suffering from an incurable illnessexpected to cause him severe distress or render him incapable of rational existence"—(I am quoting here from subsection (2) of Clause 1) but for the time being the patient may be capable of leading a reasonably satisfying life, and the distress or incapacity may not reach an acute stage until some time in the future. Even if euthanasia were acceptable in principle, it would seem wrong to permit it to be carried out before the patient's illness had reached a stage where he was suffering pain or incapacity. It might be possible to incorporate some safeguards in regulations made by my right honourable friend, or in conditions attached to the patient's own declaration, but in a matter as important as this, my Lords, surely the position ought to be made clear in the Bill itself. Yet it might be extremely difficult to devise a satisfactory provision for this purpose. A further point that must be made, and which I have no doubt will be made again and again in the course of this debate, is that, as Lord Horder so wisely observed in the course of the 1950 debate:… it is a fact that the disease that is incurable today is cured next year"—[OFFICIAL REPORT, 28/11/50, col. 567.]1171 The Bill would also seem to have serious gaps in relation to persons who are mentally incapacitated, either at the time of the declaration or at the time euthanasia is administered, or who are unconscious at the time euthanasia is administered. There is no requirement as to the state of mind of a person signing a declaration other than the statement by the witnesses that he appeared to appreciate its significance, and cases might occur where a person makes a declaration, apparently of his own free will, but without clearly understanding its import. Such a person might also agree to euthanasia being administered without fully realising what was being done. Clause 4 of the Bill requires a doctor, before causing euthanasia to be administered, to satisfy himself, in the case of a mentally responsible patient, that action is being taken in accord with the patient's wishes. In other words, he has a final opportunity to change his mind. There is, however, no such requirement if the patient is not mentally responsible then, but who may have been responsible when he signed his declaration. He thus has no last chance to change a decision which may have been made many years earlier.
The same situation applies where the patient is unconscious at the time euthanasia is administered, for there would be no way of determining whether or not this was still his wish, and in some cases the declaration being acted upon might have been made, as the noble Lord, Lord Newton, I believe, pointed out, many years previously. I must remind the House here that although Clause 2(1) limits an initial declaration to a period of three years, Clause 2(2) would enable it to be re-executed for an unlimited period. There would, therefore, be the practical difficulty in some cases of ensuring that any action taken was in accordance with a genuine wish of the patient at the time; and the possibility of abuse cannot be entirely ruled out.
Even if all the practical difficulties of ensuring that all the safeguards incorporated in the Bill were complied with, it would be by no means certain that even these safeguards would be adequate against abuse. Supposing, for example, euthanasia were administered on the basis of a declaration which was afterwards alleged to be forged, or signed tinder circumstances which rendered it 1172 suspect, the Bill would appear to protect the doctor who in good faith administered euthanasia, but it might in practice also protect those who had been responsible for the false declaration. The vital witness would in many cases be the patient himself, and once he had died it might be virtually impossible to prove whether the declaration had been genuine or not, particularly if the witnesses could not be traced; and even if there were strong grounds for suspecting that the declaration was not genuine, it might be difficult to prove who had been responsible.
Among other points that cause concern—and this was another point which the noble Lord, Lord Newton, raised—is the tact that Clause 3 provides for a declaration to be revoked by destruction or by notice of cancellation shown on its face. But what happens in the case of a patient who had expressed a wish to revoke his declaration but where, for some reason, no action had been taken to destroy the document or to endorse the revocation on its face? As the Bill is drafted, it appears that a declaration might be made many years before it came into effect. Thus a person may re-execute his declaration under Clause 2(2) at the age of 23, or presumably at 20 if and when the age of majority is lowered to 18, and find it being acted upon 50 or even 60 years later. If by then he is mentally incapable or unconscious, it would be acted upon without his knowledge or his being given a chance to alter it. It seems desirable, to put it no higher, that in a matter affecting life and death a declaration should not be acted upon many years later unless there was equally well attested evidence that the patient was still of the same mind.
Again, it is not difficult to imagine a situation in which the provisions for conscientious objection (Clause 4(3)) and for the appointment of responsible physicians (Clause 9) could not be reconciled with the form of declaration in the Schedule. This, among other things, gives discretion to "the physician in charge of my case", and the physician in contemplation when the declaration was made will often be different from the physician in charge when the patient qualifies for euthanasia. Another difficulty is that Clause 8 appears to give 1173 a patient a right to pain-killing drugs. This was touched upon by the noble Lord, Lord Amulree, and those of your Lordships who, like him, are members of the medical profession may feel that there is a fundamental objection to this clause, in that in speaking of entitlement to drugs it trespasses in the field of clinical judgment, and that far from removing doubt it may, because of its introduction into a Bill concerned with euthanasia, undermine public confidence in the administration of pain-killing drugs in connection with less vital medical and surgical procedures. This I find to be a very real fear.
The difficulties to which I have alluded do not form an exhaustive list, but I am conscious of the number of noble Lords who follow me and your Lordships may think that that list will suffice to demonstrate that the provisions of this Bill exceed in our view the bounds of what is practically possible, both in terms of safeguarding the rights of patients and of appointing doctors with special responsibilities in relation to them. I would only say, in conclusion, while again stressing that this is clearly a matter for the individual conscience of each noble Lord, that it is the Government's firm view, ethical considerations apart, that the practical difficulties of prescribing by Statute for the administration of euthanasia are so grave as to render this Bill unacceptable.
§ 4.24 p.m.
§ LORD BROCK
My Lords, my first reaction to this Bill is one of extreme distaste and of some dismay that it should have been introduced. My distaste for the Bill did not extend, with certain reservations, to the actions of those who are sponsoring it. I modified my distaste because I thought that the essential motive for introducing the Bill was compassion. This can be a worthy motive and deserves respect. But in such a weighty matter as definitive, premeditated killing it is essential that the whole substance of the proposal should be looked at calmly. Our compassion should be restrained and controlled by reason.
But I could not understand Clause 2 of the Bill, which states that the declaration of the wish to undergo euthanasia shall remain in force for three years and that by a patient's re-executing the 1174 declaration it will remain in force for the lifetime of the declarant. When I turned to the Schedule, on page 4 of the Bill, which sets out the form of declaration to be signed, I had my explanation. It is simply that it is suggested and intended that it will be possible for a healthy man or woman to request that he or she be put to death if at some unspecified future date, perhaps many years ahead, he or she is thought to have a serious physical illness or impairment reasonably thought to be incurable and incapable of alleviation from suffering by treatment. In this, we lose the atmosphere of compassion. The procedure is more like joining a sort of club, or a gimmick of some sort. It is so naive as to be breathtaking. Instead of "Alcoholics Anonymous" we have elective euthanasia. This proposal is so unacceptable that I do not wish to give it any more consideration in this debate, except to say that the very fact of its being in the Bill destroys one's confidence in the sole redeeming feature which it seemed the Bill might have; namely, the quality of compassion.
My Lords, in common with most of you I am filled with compassion for those unfortunate individuals at whose release from pain and suffering this Bill is in some part directed. As a doctor I have seen, and still see, many harsh and tragic cases for which death alone can bring release and relief from suffering. This I freely admit; and in this regard I respect the motives and emotions of many of those who sponsor or support the Bill. My compassion for the sufferers, my recognition of the compassion they deserve, does not, however, lead me to support their killing by doctors. It is not possible or reasonable to brush aside the ancient Commandment which forbids killing and which has been ratified by many nations for many millennia. Now we have, in the baldest terms, the proposal that killing can be made legal by an Act of Parliament.
Those, my Lords, are my general thoughts, as an ordinary individual, on the proposals in this Bill, and I put them forward for what they are worth. But I must also speak as a doctor and give what I think should be the thoughts of most doctors. I cannot speak for all doctors for, like any other community doctors will have different views, experiences and thoughts. We are all exposed to the 1175 argument that the proposed killing is mercy killing, disguised in some part by the term "euthanasia". Many lay people, and doubtless many noble Lords in this House, may feel that mercy killing by the State is justified and acceptable. It is my responsibility to try to present what I consider should be the approach, the actions, of doctors to this proposal. It is quite simple: they cannot and should not, as doctors, have anything to do with it. For doctors the problem should begin and end there; but some elaboration is needed.
The essential, the absolute, duty of a doctor is to his patient. Once he accepts a human being as a patient that patient's interests are paramount. The basis, the absolute essential, of the relationship between patient and doctor is complete confidence and trust. This is a relationship that is almost peculiar to the practice of medicine, and without it the rock on which the successful practice of medicine is built would crumble away. If the patient is aware that at some secret, unannounced moment, his doctor may kill him, all confidence goes and is replaced by fear. The same applies with no less force to the nurse, who is also empowered by this Bill to kill her patient. But, the Bill says, killing is to be countenanced only if the patient makes the solemn declaration of his firm wish to be killed. This is a shallow and unacceptable argument, and a particularly perverse one, because it seems or claims to be founded on the desirable motives of mercy and compassion. If I were speaking as a layman I would comment that "The Devil can quote Scripture for his own purposes"; but I must confine myself to the duty of the doctor.
My Lords, I accept that circumstances or conditions may exist in which death is a happy release for a particular individual. His suffering may be more than he can be reasonably expected to bear and more than anyone could wish to continue. But to end his life by killing should not fall to the doctor: the law should not direct, permit or encourage him to do so. If society wishes to kill the sick and suffering then it should do it itself, as I understand is customary in some primitive tribes, and not try to persuade the medical and nursing professions to do so. I do not intend to argue, to 1176 itemise, to present in detail arguments against encouraging or persuading the doctor to kill. I merely state that the doctor—all doctors—should resist it.
In case your Lordships should think that this view is mine alone, I will read to you an extract from decisions of the Council of the British Medical Association, and one from a report of the Central Ethical Committee. The first is a minute of a meeting of the Council in 1950. It reads as follows:RESOLVED: That the World Medical Association be informed that the Council concurs with the following pronouncement.'Whereas, the Council of the World Medical Association believes that the practice of Euthanasia is contrary to public interest and to medical ethical principles as Nell as to natural and civil rights, and'Whereas, such practice is contrary to the spirit of the Declaration of Geneva, therefore.'BE IT RESOLVED, that the Council of the World Medical Association in session at Copenhagen … recommends to the national medical associations that they condemn the practice of Euthanasia under any circumstances'.Secondly there is the Report of the Central Ethical Committee to the Council of the British Medical Association. It reads as follows:The Committee received a resolution passed by the National Council for Civil Liberties at its A.G.M. calling attention to 'the natural right of individuals to seek euthanasia for themselves when their lives have become intolerable, and for their doctors to be able to help them without risking a felony prosecution'. The Committee could not subscribe to this view and reiterates the policy of the Association that the practice of Euthanasia under any circumstances be condemned.No doctor of any experience could have failed to learn from his knowledge of human beings and of his patients that no patient can be a proper judge of the desirability or inevitability of his death. The chances of error on the part of the patient, or of his relatives, are great and complex. The chances of error on the part of the doctor, even of two doctors, one of whom is of consultant status, are so great that I do not think that any useful purpose would be served by elaborating them to an intelligent audience such as I now address. It would be easy, but tedious, to elaborate on many instances and precise examples in which gross, unforgivable error could occur and has occurred. Some excellent examples have already been given by the noble Earl, Lord Cork and Orrery.
1177 Even if the patient's wish to die were based on great suffering and the incurable nature of his complaint, the knowledge that at any moment his doctor or his nurse would destroy him could create a terrible situation. Every time his doctor entered the room his thoughts could be, "Is this man about to kill me?" Again, doctors of experience will have no difficulty in knowing the nature of the patient's reaction. I repeat, my Lords, if society wants to destroy the sick then it should do so itself and not get doctors and nurses to do it.
Not many months ago we were debating the legislation of abortion for social, non-medical reasons and I recall what I wrote and spoke about this only two years ago. I said:If the will expressed in the Bill is to be implemented it will be necessary for the Government to provide the individuals to do these operations. Unless doctors in sufficient numbers are willing to comply this will mean a new cadre; a form of public official; a public abortionist, similar to a public executioner. Such a calling is not likely to remain restricted in what it does for long. The next step would be sterilisation of men and women on demand or by direction on purely social grounds. The next logical step after that would be euthanasia on demand or by direction.I never thought, my Lords, that in my own lifetime, indeed, after barely two years, I should see an attempt to enact this legislation.
This is what I classify as a "road to En-dor situation." It reminds me of Rudyard Kipling's verse about the road to En-dor:Oh! The road to En-dor is the oldest road And the craziest road of all!Straight it goes to the witch's abodeAs it did in the days of Saul.And nothing is changed of the sorrow in storeFor such as go down on the road to En-dor.My Lords, we have already set our feet on the road to En-dor and we should tread carefully, lest we plunge down a slippery slope to much sorrow.
I hope that I have not given the impression that doctors have, and should have, little or no compassion in the presence of severe and prolonged subterminal suffering. Of course they have. The attitude the doctor should have is best presented in the "12th Commandment "—Thou shalt not striveOfficiously to keep alive.1178 The meaning and teaching is reinforced if we add it to the 7th Commandment:Thou shalt not kill—but thou shalt not striveOfficiously to keep alive.Up to now I have spoken in general terms of my thoughts on this Bill. I wish now to make certain specific proposals within the Bill. I have already referred to the extraordinary and naïve intention of the Bill:… to enable persons to request in advance the administration of euthanasia in the event of their sufferingsome irremediable condition at a future date. I can understand, and indeed support, the anticipatory bequeathing of various tissues or organs for grafting purposes after an individual's death, but the present proposal is completely unacceptable. Clause 5(2) states that:Physicians and nurses who have taken part in the administration of euthanasia shill be deemed not to be in breach of any professional oath or affirmation.Again, I find this breathtaking in its naïvete.
My Lords, it is commonly thought, and often stated, that doctors take a professional oath. I am told that there are some universities and medical schools in the world who require their medical graduates to affirm solemnly the Hippocratic oath; chiefly, I imagine, to impart a flavour of antiquity and historic atmosphere. But the vast majority of doctors, and certainly of nurses, take no such formal oath. All the same, they are bound by certain standards of conduct and behaviour, perhaps even more than if they had affirmed by a solemn oath. This conception, this intrinsic sense of duty and standard of conduct, applies to other professions and to many other things in life as well as to the obligations, responsibilities and duties that a doctor recognises.
Some things are not binding by oath but are governed by codes and standards of conduct stronger than those imposed by the taking of an oath; perhaps fortunately so, when we are now told that an oath is never so binding that it cannot be evaded by an Act of Parliament. There are certain things that are not done and which cannot be made right or acceptable by legislation. As a crude example, it would not be the thing to expectorate on the Floor of this House, or to kick a 1179 policeman in the face when he is lying defenceless on the ground. You cannot make such things right by an Act of Parliament, and I cannot see how you can tell a doctor or a nurse that by means of an Act of Parliament it is all right for them to kill a patient. The only thing an Act of Parliament can do is to permit or direct someone, anyone other than a doctor or nurse, to do so.
Finally, my Lords, Clause 8 states that in a terminal state a patient whose severe distress cannot be otherwise relieved should be entitled to drugs rendering him continuously unconscious. This is an unnecessary and irrelevant observation and I would remind your Lordships of a remark I made earlier:Thou shalt not striveOfficiously to keep alive.I hope, my Lords, that you will not give this Bill a Second Reading.
§ 4.36 p.m.
THE LORD BISHOP OF DURHAM
My Lords, as the noble Lord, Lord Brock, has just remarked, all who have seen people dying in circumstances of great agony and distress, and all who have shared in the distress of relatives on those occasions, will surely sympathise with the compassion and concern which undoubtedly lies behind this Bill. Further, I frankly acknowledge, as the debate no doubt will make plain, that there is no one Christian view on voluntary euthanasia. As the noble Lord, Lord Raglan, has already said, the theology of suffering and illness (and I say, "Thank God for it!") has changed enormously over the past three or four hundred years.
But, variations aside, on this issue all Christians will, I think, share with all others a respect for human life; a conviction, as Professor H. L. A. Hart put it, about the natural right of a man to survive in society. And then, as Christians, they will be guided by the work of Christ in healing and relieving distress, the parables of compassion; and, not least, the two great Christian Commandments of love. They will also take into account the point that no man ever lives—or dies—to himself; that there is a social dimension to all we do. With respect to the noble Lord, Lord Raglan, I do not think that any of us are ever, in life or death, isolated individuals with that kind of isolated freedom.
1180 But against that background one thing has to be said when we attempt to relieve distress and to show love and compassion in a way that brings death: is this to respect human life and to do justice to the right of a man to survive in society? That is obviously the basic question of euthanasia, and it arises, as your Lordships will recognise, in four possible contexts: the context of pain, the context of keeping alive by highly artificial means, the context of severe mental distress and, last of all, the context of alleged social desirability. With my eye on the time, and bearing in mind what the noble Lord, Lord Beswick, said to us earlier, I shall not go into details.
Summarily, I would say that in the context of pain the argument for voluntary euthanasia has been much weakened by the developments in pharmacology and with analgesic drugs. Something like euthanasia might well in principle be morally justified in the keeping alive of people by extraordinary means. The Committee of which I was a member, whose Report was published under the title, Decisions of Life and Death, decided after long consideration that in some particular cases of what is popularly called "vegetative existence", and under certain conditions carefully laid down, it could be morally justifiable for those extraordinary means to be withdrawn at some particular stage. Euthanasia—and obviously I speak now out of much ignorance—would, I think, be highly problematical in the case of severe mental distress largely because, if I may presume to say so, of our relative ignorance of mental illness, and, because, in an area of this vital importance, where the facts may be in doubt and the full circumstances elusive, we surely have a duty to be cautious when we are dealing with human lives. I hardly need say anything more about the fourth case than that euthanasia is likely to be particularly hazardous in the case of alleged social or (dare I say?) political desirability.
Part of the trouble with this Bill, it seems to me, is that it tries to cover too many cases and to range over too wide a spectrum. Supposing we agree, as I have done, that in some cases euthanasia might be in principle justified; supposing, in other words, that we hesitated, as I hope we shall often hesitate, to have any- 1181 thing like a universal moral negative, does a prior declaration, which seems inevitable if euthanasia is ever to become a legalised general practice, help? Or does it make present difficulties even worse? That, it seems to me, is the crucial question which this Bill raises. Does a prior declaration, which seems to be an administrative and legal necessity if we wish to give individual moral decisions a statutory context, help the case? My view is that the undoubted need for a declaration brings with it so many difficulties that the Bill turns out to be not for the benefit for humanity but to its detriment.
A declaration might seem so reasonable for each of us in Westminster, in the cool hour, something like a private affair between ourselves and our doctors, and something done with the reasonable approval of, and after full philosophical discussion with, our relatives. But I fear that, once we make anything possible in law, legality is often interpreted by the ordinary man as conveying some kind of universal encouragement, and even prescribing a duty. In this way, it seems to me, society would be in grave danger of complicating an already difficult situation by encouraging fears and increasing anxieties—in order words, of developing the very kind of situation which the Bill in principle is designed to avoid. For illness always involves a mixture of fears and confidences: fears of the illness and its outcome; fears of death; fears of the implications for one's family, and so on. Normally, these fears are overcome by a confidence in nurses and in doctors, in relatives and, finally, no doubt, in the law. But would not a declaration made in altogether different circumstances from those in which it was used become the dominant and crucial feature in this highly complex and far-reaching personal situation? Is it right that this should be so? Let us think just a little more about this situation.
By contrast it might be said that, taking only the case of pain or the use of extraordinary means, these situations involve the balancing of so many different and delicate considerations that the decision might most reasonably be left to a doctor, in whom one had confidence, and one would have the greater confidence the greater the doctor's expertise and the better his training in moral-decision 1182 making. Such a doctor, I hope, would as a student have been to courses like those to which the noble Lord, Lord Amulree, referred, organised by the London Medical Group, or in later life might have shared in some of the discussions that are organised by the Institute of Religion arid Medicine. It is of course obvious that the alternative to euthanasia is not the delaying of death by all possible means, as some seem to think. As the noble Baroness, Lady Serota, said, there is no moral difficulty whatever, on any theory, about administering analgesic drugs which would at the same time both lessen pain and shorten life. There are many moral devices—appeals to a doctrine of necessity, or the law of double effect—which can explicate the legitimacy of such action.
But, my Lords, I come back to my point: are there not too many particular difficulties about the declaration? It is obviously very difficult for people who are seriously ill or dying to make, a month before their death, a reasonably clear declaration of their intentions and desires. Yet we need also to reckon with a general disinclination to talk of death—evident in the case of wills—even when a person is in the best of health. It is "not clone" at tea-time on Sunday afternoon to start long discussions about death: there is felt to be something slightly improper about it. When should we start the discussion leading up to the declaration? In any case, let us never underestimate the ordinary man's difficulties with forms—and none of us would want euthanasia to be a privilege of the highly educated. Further, even if a wish for euthanasia is expressed beforehand, various difficulties arise, against which witnesses are no guarantee. Could circumstances at such a distance ever be specified in sufficient detail? To take a phrase from the present Bill, how severe must "severe distress" be?
Once a declaration had been made, it would subject doctors to all kinds of complex and unfair pressures, which could well become intolerable. Relatives may be unscrupulous but it would be just as difficult if they were equally insistent and pleading. Supposing they said, "Don't do it for him, doctor," what then would the doctor do? Sooner or later, the relatives would want to know whether or not the death had come about because 1183 of the declaration. New and highly complicated ingredients would be brought into what is already a highly complicated situation. The point has already been made by the noble Earl, Lord Cork and Orrery: was this precisely the kind of "severe distress" which the patient had in mind all those years ago? Further, always over-arching the situation is the utter finality of death, so far as human life goes, and the difficulty that, from the nature of the case, this declaration becomes of use only in circumstances in which the patient has no power whatever to withdraw it. The point has already been made by the noble Baroness, Lady Serota. Again, let us recognise that it is easy to misconstrue remarks made by sick people in relation to the possible demands mentioned by the noble Lord, Lord Amulree. When patients say, "I want to die", what is most often wanted (even perhaps with the lady in her nineties to whom the noble Lord referred) is help and treatment. "I want to die" is most often a plea that something should be done to make life more bearable: it is very rarely a request that death should be brought about immediately.
My Lords, I am very concerned for the ordinary man and woman, lying in a hospital ward where some have made declarations and some have not. A patient in one bed dies. Imagine the whisperings around the ward when the sister has gone out: "Did he ask for it?" Or the reply, "No, but I think I ought, or should I not?" Or when the declaration has been made, the patient may worry. "Where now did I leave it? The last time I saw it, it was in the bottom drawer of the dresser. But did someone spring-cleaning happen to remove it and tear it up?—because if, so, it has been revoked." Not everybody has boxes and safes in which to keep these precious documents. They could just as well be put in with the gas bill or the butcher's bill down in one corner of an old drawer at the back.
As the noble Lord, Lord Amulree, suggested, hospitals and doctors might well get the reputation, just or otherwise—it may be utterly unjust—of either welcoming most those who had declarations in their hands or of taking a wide view of severe distress, or even taking people's word for it that a declaration had been 1184 made. You can picture the conversations: "Oh, has he gone into North Street Hospital? Well, it won't be long now before he's gone." Again, who injects the lethal dose? It would often, I fear, be a poor nurse, who even after what I hope would be a prior consultation, and a genuine consultation, might well be haunted, as I know some nurses have already been, by the thought, "I killed him." Then she might say: "But he must have wanted it. Or did he, in those circumstances?" And we see all the difficulties, the distress, the uncertainties and anxieties that would be generated.
In any case, if I may say so, it would seem to be a singularly inopportune time—and I deliberately refuse to use the words a "ripe time", which is always pejorative—to introduce these practices, for, I repeat, I fear that the medical profession is becoming more and more associated in the ordinary person's mind with death and experimentation rather than with health and care. I am sure that no one would resist that judgment, even the doctors themselves, who must be distressed by it.
My argument is not however that we leave things as they are. Nor would I want my own decision to be determined by the possible risks that this Bill might bring in, say, the field of alleged social and political desirability. I am quite prepared to see that any moral advance brings with it great risks and it will be an extremely disastrous day when Christians give the impression that they will not take any risks in reaching moral decisions. They will then, indeed, display that harsh, unyielding obscurantism, and even give the impression that they know all the answers beforehand.
My positive suggestions would be these. There is an obvious need to disseminate by teaching and practice recent knowledge about drugs and terminal illness. I fully support the plea of the noble Lord, Lord Raglan, that we must have better terminal care of the kind that already exists in a number of institutions. We need to bring together those whose experience is of people dying even nowadays in great pain, and those who have already found ways of enabling terminal illness to have such relief as to leave the patient mentally alert and peaceful. Let us see just how far those residual cases of pain and 1185 distress, sometimes given as 15 per cent., could be reduced.
Thirdly, I wish, with the noble Lord, Lord Amulree, that medical education could take more serious note of the daily increase in the number of medical social problems for which there should be explicit training. In the absence of these, or even as a supplement to them, we must certainly publicise and develop the work of such groups as the Institute of Religion and Medicine and the London Medical Group. Finally, if there is any doubt whatever about the legality of withdrawing artificial means of survival when a considered medical moral decision judges it to be right—though I am not convinced that there is—no doubt this is something which needs seriously following up.
But looking back on the Bill as a whole, I am bound to conclude that, far from being a great asset, it would be an enormous liability to the community because some kind of declaration is in principle an assential feature of the Bill. I hope that the concern, compassion and sympathy which surely lies behind this Bill can be shown in other ways without eroding confidence in those on whom health and life depends, and without increasing the anxieties and distress it seeks to reduce: in short, my Lords, without introducing more difficulties than it avoids. That is why, if it comes to a Division, I am bound to vote for the Amendment.
§ 4.55 p.m.
§ LORD AILWYN
My Lords, we have listened to the right reverend Prelate with the greatest interest, but I rise to support in a few words the Second Reading of this Bill, and to congratulate the noble Lord, Lord Raglan, on his courage in presenting it and the skill with which he introduced it. He will not be deterred, I feel sure, by whatever volume of opposition he will find and, in fact, has already found in regard to this measure—opposition that was powerful enough to defeat both a similar measure in 1936 and a Motion on similar lines in 1950. My own impression is that public opinion on this matter has changed since those days, and is gradually moving in the direction advocated by the noble Lord, Lord Raglan, and his supporters.
1186 What is the aim and object of the Bill? Is it not just this—to use the words of the late Lord Denman in the debate on the 1936 Bill:To substitute for a slow and painful death a quick and a painless one."?That seems to me to put the matter in a nutshell. Further, is it not to provide a sufferer undergoing ceaseless pain and agonising suffering an escape route should he desire to take it? Is it not to extend to the human sufferer the same degree of consideration and compassion that we extend to our ailing and ageing animal companions? Why are we more merciful to our four-footed friends than we are to humans? How can such a palpable anomaly, or, as I would call it, patent idiosyncrasy, be justified?
I give way to nobody in my admiration for the skill, care and devotion of the medical profession; and after reading the speeches of distinguished doctors and surgeons in the two former debates in your Lordships' House on this subject, I do not underestimate for one moment the difficulties, or fail to understand the medical standpoint. Nevertheless, it is interesting to remember, in this connection, that the Voluntary Euthanasia (Legalisation) Bill in 1936 was conceived by one of the most distinguished surgeons of the day, the late Lord Moynihan, who, alas! died before he was able to introduce it in your Lordships' House. That Bill, as your Lordships know, was moved in the event by the late Lord Ponsonby of Shulbrede, and was defeated by 35 votes to 14.
My Lords, if I wanted any reassurance of my own views in favour of euthanasia, I got more than enough a few day s ago while visiting an old people's hospital. Rows upon rows of beds, each holding a human being lying there inert, some sleeping, some perhaps under sedation, some with their eyes open looking utterly listless, hopeless, lifeless, in a kind of torpor. One felt stifled with the all pervading apathy, the lethargy of the whole atmosphere, the intense sadness of the whole scene. If ever one wanted confirmation of the urgent need for a reappraisal of the whole subject of euthanasia—and this Bill mercifully lights the torch in that direction—here it was in all its pathetic reality, the crying need to offer these poor creatures the one 1187 remedy one felt in one's bones that they might accept gratefully and thankfully grasp.
But the noble Earl and his supporters will have none of it. They would deny them—I must say that I do not want to misinterpret what the noble Earl has said; he spoke with great sympathy on the salient features about what we were trying to do—this relief, this escape. He would withhold from them this boon, this milk of human kindness. My Lords, that is a melancholy thought.
§ THE EARL OF CORK AND ORRERY
My Lords, will the noble Lord forgive me for interrupting? I hope I made it plain that I was not opposed to euthanasia. I was opposed to this Bill. I have said nothing—if I have, I now contradict it—which would in any way justify the noble Lord in saying what he has just said.
§ LORD AILWYN
My Lords, if I have in any way misrepresented the noble Earl, I withdraw immediately.
As to the religious side of this problem, I am a little daunted by the somewhat imposing phalanx of lawn sleeves and other accoutrements facing me. Nevertheless, I must say my piece. I suppose it is natural and perhaps inevitable that right reverend Prelates should oppose this Bill. And yet, all teaching of the Church is based on the theme of an after life. Surely it can be argued that a suffering mortal in this world should be given the right to opt out of his present existence when his agonies or other pressures become insupportable, and be wafted painlessly into the life to come. If I may be forgiven for further trespassing in the realm of Lords Spiritual, can we not resolve this terribly important question by emulating the words of St. Paul in I Corinthians, XIII, 13:And now abideth faith, hope, charity, these three; but the greatest of these is charity"?
§ 5.3 p.m.
§ THE EARL OF LONGFORD
My Lords, the noble Lord, Lord Ailwyn, has spoken with immense conservity and I can agree with one thing, at least, he said—I think only one, but one thing—when he paid a tribute to the noble Lord, Lord Raglan, for the courage and skill, and he might have added the dignity, 1188 with which he introduced this Bill. I may come back to one or two things which the noble Lord said, but I hope he will forgive me if I do not follow him closely but turn instead to a brief statement of what may be called the ordinary Roman Catholic point of view. We Roman Catholics are not so monolithic as we used to be. One of my Anglican friends—a Bishop, indeed, or one almost higher than that, if one can be higher—said to me not long ago, "I feel much more in sympathy nowadays with you fellows who are having such good rows. We have had them, of course, for years." Certainly there is much more variety of opinion, or openly expressed opinion, in the Church than there has been in the recent past. But on this one subject I do not think there will be any difference among the Roman Catholics one is likely to encounter.
A moment or two ago I had pressed into my hand this telegram. If I quote it, it is not because I think it is going to impose its authority on anybody outside my Communion, but it might just interest the House:Roman Catholic Archbishops and Bishops of Scotland meeting in Aberdeen gravely disturbed at proposed legislation on euthanasia. Strongly support all who oppose this Bill. It will undermine Christian principles of morality and maintenance of human rights".That is signed by the Secretary of the Roman Catholic Scottish Episcopal Conference. I have no doubt that the Roman Catholic hierarchy in England and Wales will agree with that.
We Roman Catholics—and if I speak in that way it is not to imply we have some unique doctrine here—together with all who believe in a personal God, regard God as the supreme Lord and Master. In an absolute sense, all things belong to him. We are the custodians of life—that is all we are—and the life of each person in the world belongs to God. If one starts from that point of view one is opposed to all forms of euthanasia. In principle we consider that we human beings have no right to take life, whether our own life or someone else's and whether or not that someone else, as explained by the noble Lord, Lord Newton, has requested this operation to take place. That is a short statement of the Catholic and, I should think, the general Christian standpoint in its simplest form; and it is not likely, I should judge, to be altered.
§ LORD SOPER
My Lords, will the noble Earl allow me to ask him a question? Does that law apply to the killing of other people in war?
§ THE EARL OF LONGFORD
My Lords, strangely enough, with my great pacifist friend to follow me, it occurred to me that he might ask that question. I would only say that the question of killing in war has tortured Christians, as he is well aware, throughout the centuries. But when I have finished I must leave him to decide. He has every opportunity of commenting on my remarks as he speaks next. I leave him to decide whether or not euthanasia, according to the principles I am enunciating, would be justified.
If one takes the ground I have just ventured to take, as an ordinary Roman Catholic and possibly as an ordinary Christian, I think one must meet one particular question that has been running through this debate without perhaps being posed in quite this form. Someone called euthanasia "suicide by proxy"; but at any rate it is an arrangement under which a doctor is allowed to help a patient to commit suicide. I may be asked—and I think one must face this question quite fairly—"If suicide is now legal, or at any rate not illegal, why should it he a crime to help somebody to commit it?". That seems to me a point which anyone who is strongly opposed to euthanasia and accepts the Suicide Act 1961 must fairly meet. Briefly, as I see it, the answer is this. Leaving out a few extreme cases which some would call suicide and some would not but where life is surrendered in the interests of somebody else—such as (shall we say?) in the case of the heroic Captain Oates—we do not approve of suicide. We are full of compassion, I hope, for anyone who commits it. We are very loath, indeed rightly, to prosecute anybody who tries to commit suicide because we consider that he is labouring under tremendous stress. The balance of his mind in a general sense can fairly be said to be disturbed. We are, as I say, full of great sadness and great compassion for anybody who commits this fatal act. But that does not provide any sort of justification for the particular kind of suicide conspiracy suggested in this Bill.
1190 We must assume that all the doctors concerned are in their right minds; they are not mentally disturbed. There cannot be any alibi on those grounds. And in most cases I think, though not all, under the proposals of the Bill the patient when he makes a declaration is himself supposed to be in his right mind. Even if that is not so in all cases, we must assume that the doctor who is to be given this licence is not to be excused on the ground of any sort of mental disturbance. So that argument falls to the ground.
I have stated a simple principle, but we are all well aware that nothing in life is quite simple and that every statement of broad principle gives rise to legitimate questions. I shall be asked whether our insistence on the sacredness of life means that doctors are not to be allowed to relieve extreme suffering for fear that death may follow or that life may be shortened. I shall further be asked whether patients are to be kept alive indefinitely by any means, ordinary or extraordinary, long after their existence would normally have ended. The answer we give in each case is, "No". In the Roman Catholic view, it is ethically acceptable for the doctor to use any means within his power to ease the suffering of any patient in any sickness. The distinction which can and must be clearly drawn is between a treatment intended to ease the patient's lot and a treatment directly and purposefully intended to kill the patient outright; and that is t distinction I think we are all capable of making
It may well be, and indeed it often happens, that the medication recommended by the doctor will inevitably, and to the doctor's confident knowledge, shorten the life of the patient. We must face that fact. But so long as the purpose is to alleviate the suffering, the shortening of life is only a secondary or side effect, and the doctor is entitled to recommend that medication. That is our point of view.
I will now go further in dealing with the second point I raised. In our view it is quite wrong for doctors to maintain in a state which can biologically be called "life" patients who are dead to all intents and purposes; patients who are so damaged in the brain that the regaining of consciousness is impossible. One has heard of these cases. Of course, we have 1191 all heard of cases where patients are kept alive by the resuscitatory techniques. In our view this is all wrong, and here I think I am in line with the right reverend Prelate. If there is any doubt at all—and I do not say that there is any doubt—about the law at the present time I would be perfectly happy to see a declaratory Act framed and passed regarding the propriety of stopping resuscitation in these cases; but it is generally regarded as the doctor's duty to keep the patient free of pain. If there is any doubt on this matter let the law be dealt with by some sort of declaratory Act, but I am not myself aware that there is a large measure of doubt. None of this is relevant to the present Bill. I bring it in merely in order to explain the philosophy of some, at least, of those of us who are opposing the Bill.
Before I close, I want to offer two personal convictions to the House. They do not depend on any particular religious belief. They will be widely held, I should think, within the Churches, but they may be just as widely held outside. Those who oppose a measure of this kind (and it is, after all, not only strange to our law but is, I understand, unparalleled in any other country), see this, not surprisingly, as the thin end of the wedge—and none of us can see how far that wedge will penetrate. The supporters of the Bill, especially if they are young and innocent, will bristle with indignation and accuse us of misrepresentation or of introducing a red herring when we talk of, "the thin end of the wedge" or "the slippery slope". A measure of this kind is important, but there are consequences, good or ill, and one must be allowed to point out what seem to us to be the consequences.
Most of us who oppose this Bill, and certainly I myself, have no doubt that voluntary euthanasia, if introduced, will lead to compulsory euthanasia as sure as night follows day. Take the noble Lord, Lord Ailwyn—he said that we ought to treat our human friends as we treat our animal companions. No one can say that when we bring to an end the lives of our animal companions we are relying on voluntary euthanasia. The noble Lord slid over from one to the other as merrily as might be. He was drawing the example in the animal world 1192 of straightforward compulsory euthanasia, and he saw nothing odd, nothing inconsistent, in discussing the two matters as though they were part of the same issue. That may well have struck other noble Lords.
The House may recall that the noble Lord, Lord Raglan, was good enough to mention that when we debated abortion, not two years ago, I was bold enough to predict that if legislation on abortion were passed legislation on euthanasia would follow closely on its heels. The noble Lord, Lord Raglan, tried to remove any great credit I might have for this policy by saying that it was so obvious that any fool could see it. So far from it being obvious, I was rebuked far and wide by the supporters of abortion—I forget quite what they called it but it was treated as, shall we say, a typically donnish or Roman Catholic trick. It was not the sort of thing that they cared for. It was thought to be in bad taste to talk about such a thing.
§ LORD RAGLAN
My Lords, perhaps they were thinking of compulsory euthanasia and not voluntary euthanasia.
§ THE EARL OF LONGFORD
My Lords, the noble Lord referred earlier to me as someone who had made a wise but obvious prediction. I am only picking him up on his own argument and saying that for good or for ill what was ridiculed as an absurd impossibility not two years ago, is now the stage, we are told, that public opinion has reached. So we are entitled to think of this as a dynamic subject. I do not want to say, "I told you so", but I am afraid it is rather obvious that that is what I feel. I do not put this inevitable development which we are likely to see from voluntary to compulsory euthanasia, if and when it comes—I am rather happier about the prospects than I was when this debate started in the way things have gone so far—down to malevolence. No one who knows the noble Lord, Lord Raglan, or, for that matter, the noble Lord, Lord Soper, would associate them with malevolence. They are what I would call "holy innocents", but they may well be in the grip of forces that they do not fully understand. Once you abandon the idea that life is sacred, that the life of each one of us is sacred and is of very great value in the sight of God, I do not see where you are likely to stop.
1193 If you read the writings of some of the experts on the subject they move happily from one chapter to another, from voluntary to compulsory euthanasia, but once you abandon the idea of life being sacred you soon begin to ask yourselves whether there is all that point in the existence of x or Y. It may be a defective child or it may be some elderly Member of the House—and I speak as one who is now past the middle term. Once you reach that position it seems to me that the end for some of us is clear. I am not seriously worried about this House, because it is pretty good at looking after itself; I am speaking of those who are not very good at defending themselves—all sorts of impoverished old people and mentally retarded people and frail and weak vessels of all kinds.
This possibility—to me it is a near certainty—that voluntary euthanasia, if it ever came, would lead on to a very strong demand for compulsory euthanasia is not quite my final reflection. If ever we do pass a Bill to legislate voluntary euthanasia, and even if it remained voluntary, which I do not think would happen, we should be paving the way to a new attitude to our continued existence—an attitude the consequences of which would be calamitous. Suicide as a rational element of conduct had considerable support in ancient times. I thought the noble Lord, Lord Ailwyn, was stretching his interpretation of St. Paul a little wide when he began to bring him in on this side of the argument, but in fact it was the Christians who put an end to the Stoic idea that suicide was legitimate. The Stoics took a very favourable view of suicide on the whole; the founder of Stoicism, Zeno, committed suicide when his finger ached. That is a fact. That was a view that was rejected by Christianity, and I think few of us to-day would favour the Stoic or pagan attitude to suicide.
Quite apart from the question of compulsory euthanasia I think we ought to pause at this point and ask ourselves what kind of national attitude a Bill of this kind would lead to. We have recognised throughout the Christian centuries what can only be called "the duty of living"; the duty of making the most of this priceless gift of life. I suppose all of us admire the sacrifice of life on behalf 1194 of others. We feel poignant sympathy for those who are driven through much suffering to take their own lives because they cannot bear their continued existence; but we have never, surely, throughout the Christian centuries admired the act of suicide as such, and we have never taken any step which could possibly encourage it. The greatest danger in voluntary euthanasia, even if it remains voluntary, is that it would make suicide seem a natural course in many varied circumstances. It would make suicide seem the path of duty to vast numbers of old people who have hitherto believed, quite rightly, that it was their duty to go on living and who have in very many cases set a noble example, even when you could not set out very easily exactly what contribution they were able to make to the country.
Once we adopt this Bill, we initiate the thesis that we should dispatch ourselves when we are no longer demonstrably useful to the community. The question, "What is the use of me?" would begin to carry a widespread terror especially among those with sensitive or scrupulous minds or delicate nerves or, for that matter, with unsympathetic relations. Once adopt this Bill and once get it fairly established as part of our national consciousness, and there is hardly an old person, a really old person, in the country who would not suffer agonies as to whether he was not cumbering the ground and ought not to get himself put away.
This Bill is merciful in intention, mild, public-spirited, and is sponsored by those whose only desire is to alleviate suffering. But I believe that we are meddling here with very deep mysteries. If we pass this Bill, we shall be extending new approval to an attitude to life and death which is opposed to some of the foundations of human society and some of the truest instincts of the human race.
§ 5.22 p.m.
§ LORD SOPER
My Lords, in associating my name with that of my noble friend Lord Raglan, if my noble friend Lord Longford was assuming his prophet's mantle once more. I have to tell him that he will be wrong in this instance, because, though I am in favour of euthanasia, as I understand it, I can not support this Bill. I wish I could, and 1195 I much admire the insistence of the previous speaker in treating this matter as a matter of principle, whereas I could find a good deal of opportunity now, I suspect, in disabling the Bill as procedure, because I feel that it is inept. I feel that much of the criticism that has been levelled against the Bill is acceptable, and I cannot but agree with the noble Earl who proposed the Amendment, that we should not go forward with the Second Reading.
At the same time, the very reasons for which I, for one, cannot accept this Bill prompt me to the reflection that there is a great deal needed of deeper and more profound application to the principles that underly it than hitherto most people, and perhaps we in this House, have given. And it is for this reason that I would offer one or two basic principles which to me seem not only valid but agreeable to the Christian faith which I seek to uphold, principles without which we cannot frame a better Bill—for I should like to see a better Bill appear before your Lordships.
May I first say this? I have no use whatever for the idea that this matter should be left to the doctors. This seems to be a piece of cowardly escapism on the part of people who would rather pretend the problem does not exist than go though the painful trouble of making up their minds what are the principles which should guide their attitude to it. It is a very dangerous thing for anybody to play God, or to be compelled in some representations to Play God. Our experience in the Christian Church is that when parsons play God the history book is littered with their mistakes and failures, and I should not like to think that such an attitude would be imposed on the medical profession, because I do not think they would make a much better fist of it than we have done.
It is our responsibility to think clearly about it. I tried to apply my mind not so much to individual cases, of which I am not ignorant, but to certain of the words we have used, perhaps a little loosely, even this afternoon—words like "life", and "death", and "killing". "Life" is a pantechnicon word. I suppose that at this moment millions of daffodils are being massacred, and certainly hundreds of thousands of animals 1196 are being butchered. Is life sacrosanct in the flower, sacrosanct in the animal? Is it sacrosanct in man? Surely it is sacrosanct in man if in fact he is alive in the self-conscious sense. This again is a difficult word or phrase to be explicit about. But I should have no hesitation whatever in allowing to pass out of existence, as we know it, pieces of mechanism which, while organically considered alive, are yet no longer suitable for inhabitation of the spirit.
From a professively Christian point of view, I am perfectly well persuaded that there are innumerable instances in the dark places of the hospital wards of animate yet not sentient creatures living an entirely vegetable existence—if, indeed, one can say they are living at all. This is a problem upon which much greater research and careful analysis has to be made, but surely it is rather silly to talk as if any organism which shows the outward and visible signs or sense reaction or of mechanical stimulation should be regarded as of sacred value.
In any case, from the Christian standpoint, as has already been said by my noble friend—and I entirely agree—we as Christian people believe it is better beyond, at least for those who have been saved from their sins. Yet I must remind myself that my own acquaintance with people of a professedly Christian faith in their terminal condition, despite the attractions of Heaven, is that very often they cling assiduously to this world as hard as they can. Not so my beloved father, who died at the ripe age of 91 and who was much concerned at the interference of doctors, who seemed in his judgment to be delaying his departure for Heaven. I think he came to feel that somehow the Lord had mislaid his file. He wanted to go to Heaven, and I have no doubt he set out in that direction and has duly arrived. It is a little presumptuous to talk as if the ending of life is extinction. It is the gateway to Eternity, as many of us believe. It is a relevant fact, without which I think the Christian faith becomes absurd.
The second basic principle has already been briefly adverted to by the noble Earl, Lord Longford, and this is the question of suicide. One of my boyhood heroes was Captain Oates, and he committed suicide. There 1197 is no doubt about it. He left the tent, with his poor frostbitten legs which could no longer carry him and were a hindrance to the possible arrival of his friends at the next staging post. He said, "I am going out. I shall be some little time". He went out, inducing death, and that, by the definition of this Bill, is euthanasia. What indeed of Father Damien? Did he not induce death by going to a leper colony where he was completely and absolutely assured that, sooner or later, he would contract the disease which would bring him to his death. Of course he did. What of Gandhi, and his fasting to death in order to bring moral pressure on those he wished to enlist in his programme of Ahimsa?
We have had a number of quotations from the Book. I would give you:Greater love bath no man than this, that he lay down his life for his friends".What in some cases is an ignoble and cowardly escape from the responsibilities of life can in other cases be the most sublime consideration for the welfare of others and total indifference to one's own welfare in that process.
Therefore, my Lords, I have come to look at this problem of euthanasia from the standpoint of whether or not a man is justified in taking upon himself the responsibility finally of giving up his own life, giving it up for a worthy and sincere purpose. What I want to say is this: if he so desires, if it is his conviction and his belief, he has a perfect right so to do; and he has an equally perfect right for the rest of us to keep out of the way. This may appear dangerous—indeed, it reflects upon that particular part of the right reverend Prelate's speech in which he talked of "the document". But this is the nub of the whole matter. If I reached a sub-terminal or terminal condition in which I was in great and inconsolable pain, in which I was in such a condition as to be irreparable, and a cause of great sorrow and suffering to those who had to care for me, and perhaps had to spend long hours caring for me when they might be caring for somebody else, I hope that I should have the courage and the intelligence in such circumstances to opt to give my life; and if I did, I believe that I have a right to ask the medical profession to stand back and let me die.
1198 I hope they would give me such medicaments as would alleviate the pain. I earnestly hope that they would provide anæsthesia, if possible. But I would not ask them to kill me. What I would ask them to do is officially not to strive to keep me going as a piece of mechanism when I could verily believe that to be off and away was not only a way of escape from intolerable pain but preeminently a way of relieving other people of unnecessary suffering, and myself into the bargain. This is why, it seems to me, some preparation must be made by a man or a woman when relatively able to make a sober judgment against the day when he or she may be unconscious, or helpless lying upon a bed, or in such pain as to be mentally afflicted and perhaps deranged. This is the problem to which I believe we have to address ourselves much more carefully than is provided for in this Bill.
It is for this reason that I do not believe in the present Bill, which confuses the direct act of bringing somebody's life to an end, and the indirect act, it you like, of being an accessory to suicide. I believe that in certain circumstances to be an accessory to that process of exerising one's right to opt out of life, under conditions which will benefit others and will be of no final benefit to the one who opts out, is a reasonable and a Christian demand; and when we are ready I hope that we shall be prepared to look at a Bill which, difficult as it is, will enshrine in our intelligent and civilised community this human right which I believe is part of our Divine freedom and, when exercised, can be for our good.
§ 5.34 p.m.
My Lords, I am intervening in this debate as an opponent of this Bill, since I am particularly interested in the relief of pain and the tremendous and exciting strides made in developing new drugs. May I say now that, like my noble friend Lord Newton, although I speak from this Despatch Box I speak entirely for myself. I have no doubt at all about Lord Raglan's good will and concern for those who suffer; but what he suggests is most dangerous and misdirected. It is dangerous because it can easily be misinterpreted or misused. There are no safeguards which can prevent misuse by the unscrupulous, either relatives of professionals; and I do not 1199 think we could ever find such safeguards, even if we accepted the need in principle, which I do not. It is dangerous, as has been said, because we should so easily find ourselves reaching the point of deciding that others had no right to live. We need not compare ourselves with Nazi Germany, which reached that ghastly state, but, so far as I am aware, we should be the first country to initiate such legislation. Do we really want such distinction for ourselves?
It is dangerous in principle as well as in practice. If we are presented with this alternative, it would be more difficult for senior physicians and surgeons to pass on to students what they know so well, that part of medical education is to learn when to stop the complexities of curative treatment and concentrate on the comfort and relief of an individual person. What we need for this is not legislation for so-called mercy killing, but discussion and education and proper concern for people. Euthanasia is a totally negative approach. Much is said about hopeless pain and about inevitable deterioration and incurability. The situation has changed greatly since the previous Bill was introduced and defeated in this House. We have heard to-day of the immense advances in geriatrics and rehabilitation, and I should like to emphasise our advances in the control of terminal pain and distress.
I have had the privilege of being the Chairman of the hospice referred to by the noble Lord, Lord Raglan, since its planning and its inception. It was founded by a group of friends who voluntarily raised half a million pounds. It was opened two years ago for the care of patients mostly suffering from terminal illnesses and for whom hospitals could do no more. It is known to some of your Lordships, and I am glad to say that all sides of the House are represented by Vice-Presidents—the noble Lord, Lord Amulree, the noble Baroness, Lady Stocks, the noble Baroness, Lady Ruthven, and the noble Lord, Lord Taylor, who is over in Newfoundland now. I am against this Bill because I have seen what wonderful things can be done for the relief of pain and suffering by a dedicated and devoted staff. Five hundred people have died at this hospice in the last two years, since its inception, 1200 and none of them has died in pain. Most have been alert in themselves until the end. Although needing skilled use of narcotics and other drugs, these patients did not ask for the lethal injection. They asked for relief of pain, breathlessness, nausea, and so on; and when they had it neither they nor their families, who are far more likely to ask initially, ever suggested such a step.
In our experience it is far more likely that requests might come from a much smaller number of patients with neurological long-term illnesses than those with terminal cancer. I am assured, and I have seen for myself, that distress of terminal cancer can be relieved. The others can be helped through their moments of despair by understanding and affectionate care, and also be enabled to die peacefully, with dignity and without fear. I am told by various doctors that once one can recognise and cope with the cry of despair "I should like to die" as it comes from the clinically depressed patient needing treatment, or the rejected person needing attention to his problems, one is left with but few requests that could possibly be interpreted as a definite decision of the type described.
Hospices or nursing homes such as the one with which I am associated are being planned in different parts of the country. I am glad that many people come down to see what is being done, and that the right reverend Prelate visited St. Christopher's only the other day. I am very glad indeed that the noble Lord, Lord Raglan, has been there. I shall have a word to say about that in a moment. We work in co-operation with treating hospitals, and it is from the clinical judgment of both sides that decisions are made that further prolongation or resuscitation is no longer relevant to the patient's real needs. Attention can, therefore, be given to welcoming them and their families as people who wish to spend the last part of their life together in a situation where distress is relieved and where they can be free to make their own reconciliation with the situation and—although these may seem strange words to use—find enjoyment as well as peace.
What we need in this country is not a Bill such as the noble Lord, Lord Raglan, has introduced, but more money for geriatric units, for co-ordinating 1201 social services, both of which can help to make so many people active and happy in their own homes, and more hospices where we can be assured they will go gently in the course of illness itself. I am grateful to the noble Lord, Lord Raglan, for this reference to this hospice and to Dr. Saunders, the Medical Director, but surely it is an appalling confession of failure to admit, as I think he did, that we should legalise euthanasia because there are not enough places like St. Christopher's.
I should like to add a word about the families of such patients. Would they be able to bear the decisions as laid down in this Bill? All of us must have had some experience of bereavement, and perhaps know something of the feeling of guilt—which may be real or quite unrealistic—which accompanies it. I can see such a Bill as this leading not only to agony for a patient who wonders whether he ought to ask to be killed by his doctor in order to relieve his family, but also a desperate feeling of guilt by the family afterwards because they felt the patient had asked this because they had failed him.
§ LORD RAGLAN
My Lords, would the noble Lord give way for a moment? I did not say that we should have voluntary euthanasia because there were not enough places. What I said was much more than that, and much more complicated, but I did not say that.
If I have put the wrong words into the noble Lord's mouth I certainly withdraw them. What I think he did say, after his very nice tribute to our hospice, was how relatively few patients we could look after there—and, alas, we have to turn down five in six cases because there is not room for them—and he went on to talk about the very large number of old and ill people, which rather gave the impression, to me at any rate, that if we had lots of marvellous hospices where the patients could, as he has seen for himself, be given a wonderful end to their lives, there would be no need for this Bill.
§ LORD RAGLAN
My Lords, what I said is that I thought there were enormous numbers of people, including myself, as a matter of fact, who would not like to eke out their lives in that way.
My Lords, those of us who are concerned in this field feel that our views should not be imposed by lobbying of any kind but by practice and teaching, and that is being done. I do not deny that there is still a great need, or that some people are still suffering, but I would claim that what is needed is not a change of law but a change of attitude. That change of attitude would be hindered, rather than helped, by legislation such as the Bill proposes, and also by uninformed and emotional publicity. I hope that the Government will take note of all that has been said about the need for more geriatric units, more hospices and more research into the relief of pain—though let me pay a heartfelt tribute to the support and encouragement of the Ministry of Health in the endeavours with which I have been connected. I welcome this debate since it undoubtedly underlines these needs, but I do not think that this Bill is the right way of tackling this problem and I personally shall vote for the Amendment.
§ 5.46 p.m.
§ LORD PLATT
My Lords, before I go into some of the points which I wish to bring before you I should like to say something in reference to the speech which the noble Lord, Lord Thurlow, has just made while it is fresh in my mind and your Lordships' minds, and because I think perhaps it may clear up a little difference of opinion or emphasis between himself and the noble Lord, Lord Raglan. I am not so worried about the situation of terminal care in painful inoperable cancer because, fortunately, it finds its own way of termination; and, as we all know, with better drugs than we had a little while ago pain can be much better relieved.
And we all seem to be in agreement that, if the patient's life is somewhat shortened by some of the drugs which we give perhaps rather in excess—perhaps entirely by accident, or perhaps not completely by accident—then we do not mind very much; we have eased a patient out of a dreadful situation. It is much more the feeling that I (or someone I loved) might be struck down by some frightful stroke; might be "paralysed in speech and limb"—as I think the noble Earl, Lord Cork and Orrery said—and might lie there indefinitely for years; a trouble to my relations, useless 1203 to myself and to society, and quite unable to indicate to the doctors whether I wanted to live or die. Apparently the situation which the noble Earl, Lord Cork and Orrery, fears might be the result of this Bill is that, because some years ago I signed a document that if this happened to me I wanted to be put out of the way, then somebody might come and do it to me. This seems to me what the Bill is about, and I think that many of the objections which have been raised to it are precisely the points which, to me, make it so attractive: that I can, while I am still in possession of my senses, say that I do not want to be kept mischievously alive if these kind of things happen to me.
Let us take in a little more detail the kind of situations which do arise at present, and in which a certain amount of euthanasia is already used. You have a patient with a serious, painful and incurable disease—let us say cancer in this case—and he develops pneumonia. Are you going to treat him with antibiotics and cure his pneumonia and leave him to eke out the rest of his life in pain, or are you going to withhold antibiotic treatment? I know what my answer is. If you are confronted with such a patient who is in a state of mind to make decisions for himself; and if he wishes to take his own life and indicates—and this has happened to me—that if he were in possession of narcotics which might see the end of his illness he would take them, do you use all your means, do you station policemen and night nurses round him so that he cannot do this? Again I know what my answer is in those cases. Again, he may be given doses of drugs which may shorten his life, and yet unhesitatingly the great majority of the medical profession will do this in cases where they think it is indicated.
Then there are the people who have been referred to already in this debate and who, perhaps as a result of a frightful motor accident, have no hope of recovery of any kind of useful conscious life, yet who are being kept alive by artificial respirators and other machines. Surely in these cases we believe in euthanasia, do we not? It seems that, in answer to a questionnaire which was initiated by the Euthanasia Society (of which, by the way, I am not a member), 1204 70 per cent. of doctors agreed that doctors acted in these ways. The possibility of keeping a sort of "vegetable" existence going by artificial means of resuscitation and the possibility of switching it off at a prearranged time puts a new power in the hands of the medical profession. This can be both morally and legally inconvenient, but it is an inescapable result of scientific progress. If it is possible to switch off the instruments at a convenient hour when the kidneys and the heart can be used for transplants into some other individual, this is already being done and is already being accepted. Therefore, we have gone a long way towards some kind of euthanasia in some cases. What of physicians who, like myself, have made it clear to our colleagues that if we have a serious coronary attack and our hearts stop at the age of 60 or 70, or whatever it may be, we do not want to be resuscitated? Surely we have a right to decide some of these things for ourselves. So for all these reasons I came here with a view to supporting this Bill.
My only real doubts are, in the first place, how much it is absolutely necessary to make laws when a good deal of understanding exists at present, and whether this particular Bill, devising how such laws might be made, is good enough to go on to a further stage where some of the fairly obvious objections to it can be reconsidered. My own view is that those who think, as I do, that euthanasia, if properly handled and controlled—above all, the right to decide beforehand and to tell people who may be concerned what you want done in your own case—is a right and proper thing, should vote in favour of this Second Reading, even though we may have no great hopes that this particular Bill in this form will survive another stage. But we should not show our disapproval of it if we think that in principle euthanasia, in certain carefully defined circumstances, is right, as I certainly do.
I have a number of points which I have written down during the debate relating to speeches made by other noble Lords, but I will trouble your Lordships with only a few of them. First of all, may I say how much I respect the opinions of the noble Lord, Lord Amulree, in this matter, and how much I agree with him and with other speakers 1205 that education on these subjects is sorely lacking in the present curriculum of medical education as carried out in most, if not all, of our universities. Most young doctors when qualified have no idea how to handle these situations. They learn by experience, but nobody teaches them wisdom and passes on his experience—or at least this is all too frequently what happens.
The noble Lord, Lord Brock, who is clearly and definitely opposed to euthanasia, quoted the British Medical Association and read to your Lordships the resolution of its Council he also read to us the resolution from the World Medical Association, which was dated 1950, quite a long time ago. The B.M.A. resolution said that the Councilreiterates the policy of the Association that the practice of euthanasia under any circumstances be condemned".This is not consistent with the views of many medical people at the present day, as was shown by the questionnaire which was quoted to us by the noble Lord, Lord Raglan, in his opening speech.
The religious arguments may appeal to many people, but some of us believe that moral and ethical laws and medical ethics are not divinely sent to us but are the result of the evolution of thought in a society which is undergoing constant change. My Lords, knowing that there are still many other speakers, and realising that my other points have been covered by other speakers, probably better than I could have covered them myself, I feel that that is all I need to say. I have given my reasons for feeling that, in spite of the many difficulties of this Bill, we should give it a Second Reading this evening.
§ 5.57 p.m.
§ LORD BEAUMONT OF WHITLEY
My Lords, I am delighted to follow the noble Lord, Lord Platt, particularly as I am in agreement with so much of what he said. I, too, shall support the Bill in the Division lobby, even though I realise that it needs considerable amendment. I should like to make a point in rejoinder to those who have put forward the idea of the "slippery slope". This argument does not stand up, ethically or logically. Indeed, I thought that it had been finally disposed of by F. M. Cornford in 1206 Microcosmographia Academica. Surely what we have to do is to decide whether the Bill is right or wrong in itself and not discuss what we may do on another occasion if the Bill is passed or not passed.
The main point I wish to make is not to do with summoning up what might or might not be the views of a large number of sick and aged people. I hope your Lordships will not say that that imputes selfishness to me. I do not embark on this because I think it is too easy. People on both sides are able to conjure up rows of people saying that they would like to die, and other rows of people who say it but do not mean it. All I can talk about is what I experience, what I want and what I feel; and I do not think it is invalid or selfish occasionally to do that.
Here I very much follow the noble Lord, Lord Soper. I claim the right to end my life when I want to do so. The right reverend Prelate the Bishop of Durham has, quite rightly, spoken about the social dimension. But that is something which I must take into account when making my decision, because in the long run the decision to take my life rests with me. It is one which, on the whole, no one can take away from me. I reject the right of anyone to say that this right does not belong to me, or to try to enforce the taking away of that right, although I recognise the right of people to say that they do not feel that I have that right. Even the State does not now say that it is a felony for me to commit suicide, or to try to commit suicide.
The only way that right can be taken away from me is if I am in a position where I cannot myself exercise it, which is the occasion when I am most likely to want to use it. So far, I believe, I am with the noble Lord, Lord Soper. I go along with him a step further, and say that I do not wish to demand help from anyone who has any kind of conscientious objection to helping me. But I claim to be able to ask the medical profession, if and when they have no moral scruple about this, to help me to perform what I am no longer able to do myself, what I have already decided and stated firmly I want done in a given situation, without fear of retribution from the law. That is the main reason why I support this Bill, in spite of its need for considerable amendment.
§ 6.3 p.m.
§ LORD CLIFFORD OF CHUDLEIGH
My Lords, I think I am the meat in the sandwich of some supporters of this Bill. Having read the Reports of the two previous debates in your Lordships' House, I could not imagine there was anything new to be said. I mentioned that to a doctor friend of mine—a Member of your Lordships' House was present—and all he could say that was new was that the argument used in 1936 by Lord Dawson of Penn, and then again in 1950 by Lord Horder and Lord Haden-Guest, about the improvements in alleviating drugs was an even greater reason, 18 years later, for the Legislature to refrain from inflicting on the medical profession an obligation which the majority do not want. Most doctors already act on the basis that alleviation of pain is of greater importance than the prolonging of dying, and a Bill such as this would overnight ruin the doctor-patient relationship. Instead of the doctor being looked on as a friend, he would be looked on as a potential executioner—and the aged can be very suspicious. Lord Uvedale of North End said in 1950 that there were few cases where euthanasia should be contemplated and that they would become fewer as new remedies were introduced. He said that he already looked on euthanasia as an admission of failure and a counsel of despair. And that was nearly 19 years ago. I am quite certain that, from a psychological point of view, a Bill such as this would be very disturbing to the elderly.
My mother died when I was very young. When I was about 15 my father, who was still a widower, gave me Warwick Deeping's book Sorrel and Son to read. Your Lordships will probably remember that the son becomes a doctor and eventually puts his father down in the classic circumstances quoted by the supporters of euthanasia. I remember my father telling me, "Son, when I become old and useless you must arrange for that to happen to me." He was then in his late thirties or early forties. But in the last two bedridden years of his life, when I sat beside his bed chatting of old times, he made it quite clear to me that the opinions he had in his late thirties were not the same as he had in his middle seventies. On the other hand, there are some people who would sign a 1208 declaration purely because they imagined themselves to be a burden on their relations. Those people need the protection of society, not an added weapon in the armoury of suicide.
I am convinced that in the normal course of events only those suffering from temporary depression would sign a declaration, such as the boy who last week was going to throw himself from a bridge here in London because his girl gave him up. Lord Horder said that from his experience those suffering from the so-called incurable diseases were not those who wanted their lives ended, but only those suffering from what his French colleagues called the misere. Also, it seems impossible to legislate about who is in a fit state to make the declaration, because apart from exceptional cases a man would make that declaration only if he was in pain, and when a man is in pain he is probably under drugs. So that is not an easy situation about which to legislate.
About 10 days ago a young man came to my house. He was to run a discotheque for a dance, and nothing could be more modern than that. While I was discussing this Bill with a doctor friend, the young man was reading it, and he said that he thought it made a mockery of marriage. He said, in other words, "Should my wife be taken from me without my consent, because in a moment of aberration she had signed this document?" That is the point he was making and I quote it because it came from the young. Yet Clause 6 gives life imprisonment for concealing a declaration. I assure your Lordships that if my wife made such a declaration, I should do my best to conceal it.
Ethically, we come back to the value that we have set on human life. Lord Horder said:We doctors hold certain basic considerations about life. We think that every man has an inalienable right to live, and that one must not take this right from him, even if he allows one to do so on a set of circumstances outside himself."—[OFFICIAL REPORT, 28/11/50, col. 570.]With Bills such as this we cannot but ask ourselves where it is going to end. It is the "slippery slope" to which other people do not like us to refer.
From a purely materialistic point of view, I would much rather see a Bill to 1209 remove those who are born obviously insane. But there again, Hitler started getting rid of lunatics and moved easily over to the next step, which was getting rid of politicians. I also take objection to the argument that what we do to animals we should do to ourselves. I used to tell with relish the story of how when I was out riding with my wife my horse fell and we were both stunned. My wife, to my chagrin, rushed not to my side but to that of the horse. For a while I went on making a point of this story until one day a laconic type capped it by saying, "Of course, she might have had to shoot the horse".
Reverting to the medical profession, I may say that the first doctor friend to whom I showed this Bill handed it back with the comment, which was also made by Lord Brock, "Why pick on us? Go and get someone else to do your dirty work"; and Lord Horder said:… I hope the decision will not lie with our profession. There are some of our critics who might advance the view that we already kill enough people."—[OFFICIAL REPORT, 28/11/50, col. 566.]This country has now got quite a reputation, which started innocently after the war with, "Come here for your teeth or your spectacles". Now, according to "Panorama" and the article in Life, it is, "Come here for your abortion". They tell me people are now running package tours. The question is, are we next going to see that happening with "bumping-off" the old? There was a doggerel in a weekly paper recently which ran:They knocked old Granny off you knowShe only had a cold.'Her sufferings,' they said in court,'Were dreadful to behold.'The judge was kind. 'Besides', he said,'She was getting rather old.'So they left the court and went awayTo share old granny's gold.Medically, this Bill, I believe, my Lords, has been shown to be unnecessary; psychologically, it has been shown to be dangerous; ethically, it has been shown to be wrong. Solving our problems by the short cut of death cannot be right.
§ 6.13 p.m.
§ THE EARL OF LISTOWEL
My Lords, I have found in the course of my researches, with very great regret, that I am the only Member of this House alive to-day who spoke and voted for the first 1210 Voluntary Euthanasia Bill. I am glad to say that there are two survivors among those of your Lordships who voted against the Bill, one of whom, the noble Earl, Lord Iddesleigh, attends very regularly and is almost in the Chamber this afternoon. That Bill, as the noble Lord, Lord Raglan, reminded us, was introduced by my noble friend the late Lord Ponsonby of Shulbrede. It is a matter of some interest now, I think (because it shows that over thirty years ago the principle of voluntary euthanasia was already supported by leading members of the medical profession), that that Bill would have been introduced in your Lordships' House by that great surgeon the late Lord Moynihan, the grandfather of the noble Lord who now sits on the Liberal Benches, had he not died the year before.
Some of your Lordships will have noted that the 1936 Bill was defeated, in a very much smaller Chamber, of course, than our Chamber to-day, by a decisive majority on Second Reading. But I believe it started a trend of public opinion that has been growing ever since. Voluntary euthanasia has certainly more adherents now in the professions, in the Churches and among reflective people in every walk of life than it had 33 years ago. It is also much more often discussed in the Press and in broadcasting, which shows a wider public interest in the whole subject. The legalisation of suicide in the Act of 1961 is another symptom of this change in the climate of public opinion; because, my Lords, if you say, as the law does now, that it is lawful to take your own life, it is surely a logical step to go on to say that if you have an incurable and distressing illness which makes you so weak physically that you cannot do this without help, it should also be lawful to take your own life with the help of a doctor—and that is really all this Bill sets out to do.
Moreover, though we have heard, very rightly, a great deal about the ethical case on the other side, I think there is an ethical case for voluntary euthanasia which cannot, as a rule, be made out for suicide. Suicide is more often than not the action of someone running away from responsibility, whereas the decision to end a life that has become a burden to oneself and others is a decision of a highly 1211 responsible person taken after considering extremely carefully the consequences to oneself and to others. Yet, my Lords, as the law stands to-day suicide is now lawful while voluntary euthanasia is not. In view of this shift of opinion towards a recognition of the right of every adult person to choose the manner of his death, thus enlarging the area of individual freedom, and the fact that the public no longer regard suicide as an offence, I think that the noble Lord, Lord Raglan, is entirely justified in giving your Lordships another opportunity to change the law.
The argument most often used against legislation, and for leaving the law as it is, is that doctors should continue to be allowed to use their own discretion. This is the attitude of the British Medical Association to the present Bill. This argument has never been more persuasively put than it was by that most humane doctor, the late Lord Dawson of Penn, speaking in this House during the debate on the 1936 Bill. If I may, I should like to quote some of his words. He said:For the most part, this silent change has been concerned with the act of dying, and most doctors, where there is pain or struggle, bring peace at the last despite curtailment of life, and with the support and even at the request of lay opinion.… When the gap between life burdened by incurable disease and death becomes wider, then greater difficulty presents itself, and greater variety in practice holds amongst individual doctors and patients. None the less there is in the aggregate an unexpressed growth of feeling that the shortening of the gap should not be denied when the real need is there. This is due, not to a diminution of courage, but rather to a truer conception of what life means and what the end of its usefulness deserves ".—[OFFICIAL REPORT, 1/12/36, col. 482.]In other words, my Lords, what the late Lord Dawson of Penn said, and what is I think accepted by doctors, is that many doctors practise euthanasia now, regardless of the law.
The answer to this argument is, I think, a fairly simple one. Doctors are in fact saying that they have no objection to euthanasia if they administer it themselves, but they would object to doing it on behalf of society. This surely is an inconsistency that the medical profession must resolve in one way or the other. Moreover, my Lords, it is unfair to doctors that they should be expected to 1212 act upon their professional judgment regardless of the criminal law. A doctor should not have to expose himself to the risk of prosecution by a misguided or vindictive person simply because he does what he believes to be right and in the best interests of a distressed and incurable patient.
It is no less unfair to the patient, if he is the sort of patient who believes in a right to die before his life has lost its human dignity, to find himself, by the sheer accident of where he happens to be living at the time he becomes incurably ill, in the hands of a doctor whose religious or conscientious scruples oblige him to let his patient's illness take its natural course. It is surely also unfair to the patient because, I think—and I have very good evidence for thinking this—the chances of a merciful release will vary according to the patient's means. A patient dying with nursing care in his own home or in the private wing of a hospital will have a better chance of the merciful short-cut than a patient dying in a general or a geriatric ward of a hospital in a poor or working-class area. For in such hospitals—and this is no reflection on the hospitals or the doctors—the doctor realises that a very much larger number of people will know exactly what he is doing and that he is therefore running a greater risk of blackmail or of being reported by one of the staff to the hospital authorities. I am not arguing about the religious or moral objections to euthanasia. I am arguing about what I think is one of the most common practical objections to euthanasia; that is, the practice of doctors at the present time.
But I should like to deal with another objection, one that is due, I think, to a complete misunderstanding of what voluntary euthanasia means. Some people do not realise the difference between voluntary and imposed or compulsory euthanasia. This is the fallacy, if I may say so, of the "slippery slope" and the "thin end of the wedge" argument. This Bill does not propose that euthanasia should be performed except by the express wish of an adult person in a balanced frame of mind. This is the whole object of the declaration of request which can be revoked at any time and which, so that the person can still change his mind, cannot be acted upon for a least 30 days.
1213 Therefore, the mercy killing of deformed or idiot children, or the liquidation by the State of the senile, the incurable or the mentally defective has not the remotest connection with euthanasia by consent, which is what this Bill (and everybody who supports it) means by voluntary euthanasia. Let us decide about involuntary or imposed euthanasia when such a proposal is made in this House. I should certainly oppose it strongly, and I believe that other noble Lords who support this Bill would take exactly the same line. This may sound like underlining the obvious; but I think it must be emphasised so long as people still talk about voluntary euthanasia as the "thin end of the wedge" and as leading by stages to mercy killing or even the official liquidation of the unfit. I think we heard echoes of this sentiment in some of the speeches of several noble Lords this afternoon.
My Lords, the neutral stance of the Government is of course the correct and orthodox attitude of any Government towards a Bill of this kind. This was the attitude of the Conservative Government in 1936 when the noble Viscount, Lord Gage, made very much the same speech as we heard to-day from my noble friend Lady Serota. I do not think there was substantially very much to choose between them. It is the attitude invariably adopted towards controversial Bills which do not involve Government policy. Lady Serota, like Lord Gage in 1936, pointed out many of the very genuine administrative difficulties. While she said that the Bill is a matter for every noble Lord to decide upon in principle, as a matter of conscience, she very properly spent most of her speech underlining the administrative difficulties. But the decision—and may I emphasise this?—this evening, as it always is on a Second Reading of a Public Bill, is a decision about the principle of the Bill. The fate of this Bill should turn on whether or not your Lordships consider that voluntary euthanasia should be lawful. That is the principle at stake in the Bill.
There are a number of noble Lords who are opposed to voluntary euthanasia on grounds of conscience or on ethical or religious grounds, grounds which all of us respect; and they, very properly, will vote against the Bill. There are others like myself who support it and who will 1214 therefore vote for the Bill. But I have the impression that there are a number of noble Lords who are undecided or who may be against the Bill because it presents some daunting administrative difficulties, difficulties that have been pointed out very clearly by my noble friend Lady Serota. I very much hope that such noble Lords will allow the Bill to have a Second Reading; for that would enable the House to examine these administrative and drafting difficulties in Committee and, with the help of the expert medical and legal opinion with which your Lordships are so richly endowed, to find out whether these difficulties can be overcome. If they turn out to be insuperable, the Bill can still be withdrawn or rejected. I hope, therefore, that your Lordships will resist the Amendment, will give the Bill a Second Reading and will not condemn it without hearing the further evidence that we cannot get until we have reached the Committee stage.
§ 6.26 p.m.
§ LORD ARCHIBALD
My Lords, my noble friend Lord Longford implied, if he did not actually state, that only those who were young and innocent will support this Bill. I do not think that either my noble friend Lord Listowel or I can be included in the category of the young; and I doubt very much whether we can be included in the category of the innocent. I am bound to say that I first heard of euthanasia when I was both young and innocent. I was taking part in municipal election campaigning in Glasgow when one of my opponents, in the characteristic propaganda of the time, accused the Socialists of being in favour of free love, of euthanasia and of everything except the Gestapo, which in those days had not been invented. Of course, what he was referring to was not voluntary euthanasia but what we might now call "Hitlerite euthanasia".
Probably because I was young and innocent, and had had an inadequate education, I did not really know what my opponent was talking about; but as time went on I gave attention to the matter and studied it. I did not become deeply concerned about it, however, until rather more than ten years ago when my mother, then in her eighties, fell and broke her leg and at that age, in the anæsthesia for the setting and pinning, suffered a stroke 1215 from which she never recovered. For at least two years she was what has been described in the course of this debate as a veritable vegetable. She was a helpless, hopeless old lady, with no joy in life; with nothing but misery; with nothing of what my noble friend Lord Longford called the contribution of the old people to make to life. She was a burden on herself, a burden to her family, a burden to the hospital service, a burden to society.
I am bound to say that over two or more years, day by day, week by week, watching my mother in that situation, I thought more and more deeply about voluntary euthanasia. I knew that if a Bill of this kind had been in operation while she was in her seventies—because she was then a very alert, strong-minded, determined old lady—she would undoubtedly have opted to sign the declaration provided for in the Bill, so that when this mishap came about it would have been for the two doctors to decide, as in humanity they would have done, to put her out of her misery. For this reason, my Lords I do not approach this matter from a high plane of moral religious or ethical principle. I approach it from the point of view of practical, humane considerations, and I hope that, however much amendment this Bill may need in Committee, the principle of voluntary euthanasia will be accepted and that the Bill will be given a Second Reading.
§ 6.30 p.m.
My Lords, I felt that I had to say a few words on this Bill as within my group of hospitals I have an adult hospital for the severely subnormal. I have sought information from two doctors, and they both felt that they did not wish to have the burden of what they called as "acting as God" thrust upon them. Naturally, in my hospital group we have some sad cases of patients who do not know the light of day. I fully realise that these are not covered by this Bill as they could not give their consent. But, my Lords, there are mentally handicapped and confused, aged people who to my mind could be persuaded to sign the form for euthanasia although they might not fully understand the implications of their request.
I have worked for a number of years with the medical profession for whose 1216 members I have the most sincere admiration. I am not prepared to thrust upon them this added responsibility which could be interpreted as to be in conflict with their Hippocratic Oath. Why should we in Parliament rush into legislation of this kind, then quietly pass by on the other side and hand over all the responsibility to the medical authorities? Religious beliefs are still bitterly at variance over the abortion legislation, and now we have before us this Bill which would place in another's hands the responsibility of life and death. Cannot you see, my Lords, that whatever the doctors do under this Bill will appear to someone to be wrong, and that blame for an irretrievable act will be apportioned to the doctor?
My Lords, in this strange world in which we live we have not reached the stage when we can by legislation take the life of an innocent man or woman; and certainly not, to my mind, in this House can we name two doctors as the executioners of a patient. Will not some of the old, and the best of the old, feel that they have become a burden on their family and friends and believe that it is their duty to sign this form? Is this not putting ourselves in the position of procuring murder and the patient in the position of a suicide? We have all known suffering. We have also seen notices in the papers of a death after an illness bravely borne. Let us leave the future of the suffering in the able hands of the members of our medical profession who would not, I feel sure, prolong unnecessarily the life of a suffering patient.
Finally, my Lords, may I say that it is in my opinion a dangerous path that we tread in relation to this Bill. Is it not possible that in years to come this Bill, if it is passed, may be extended to those who cannot speak for themselves? Was this not the horror of the Nazis, in that the first to go were the severly subnormal? I beg your Lordships to cast out this Bill as one that is against all ethics of religion and morality and can only bring unhappiness and a sense of guilt to the doctors concerned and the family of a patient who died under its authority.
§ 6.36 p.m.
§ VISCOUNT WAVERLEY
My Lords, when your Lordships debated the Abortion Bill I repeatedly felt that there was 1217 an imperfect understanding of existing medical practice. I believed that over the centuries my profession had evolved ethics which served well. I deplored the proposition that legal rigidity should be a substitute for medical discretion. I believe that this Bill suffers from a similar lack of understanding. I would ask your Lordships' indulgence while I repeat what I said on that occasion, because I believe it is relevant to to-day's business. I said:The medical profession has been exercising discretion over matters of life and death for a long time. Public approval has not so far been withheld from this inevitable aspect of our work. I am sure that it will not surprise nor dismay your Lordships that when a patient is suffering intolerable pain from, say, advanced cancer, pain-killing drugs are humanely prescribed, nor that the alleviating dose may become so large that a merciful release happens sooner than nature herself would have permitted. That is an example of medical discretion.I imagine that few of your Lordships would support a Bill at some future time which sought to codify the precise indications for such humanity." —[OFFICIAL REPORT, 19/7/67, col. 329.]In this Bill Clause 8 is crucial. If current medical practice fulfils the requirements of that clause the others are, in my view superfluous. But your Lordships are entitled to wonder whether our present practice in fact fulfils the requirements of Clause 8. There is no doubt in my mind that it does. If pain cannot be relieved by drugs except in such a dose that will make the patient unconscious, then those drugs are so prescribed. But this is to-day at the attendant doctor's discretion and not, in the words of the Bill, at the patient's "request".
Why do I object to, at the patient's "request"? I object because the request is virtually never forthcoming and legal rigidity, far from easing the path of the dying as is the creditable object of the noble Lord, Lord Raglan, would have a contrary effect. "If the patient so requests", really embodies everything that euthanasia means, a quiet and easy death. But if left to the patient alone such would almost never happen. I have been consultant physician at the Royal Berkshire Hospital for twenty years. On only one occasion during that time has any patient seemed concerned over euthanasia. This was a retired General who had a few years previously signed a declaration similar to that proposed in this Bill. His family knew of this and his family doc- 1218 tor also knew. I saw him at consultation, when, unhappily, every personal requirement to ask for the implementation of the declaration existed. It was known that the document was in the drawer of his bedside table. I was rather apprehensive, but his mind was quite unclouded. He never raised the matter. His death was as comfortable as medical discretion could achieve.
When I was preparing my notes, I wondered whether perhaps my professional experience was too restricted and that doctors in other fields more closely involved in these tragic problems might have other experience. I have talked to one senior consultant radio-therapist, a field sadly and uniquely concerned with terminal cancer. He tells me that never, in 17 years of consultant experience, has a request for euthanasia come from a patient, even obliquely. So, in conclusion, may I beg your Lordships to reject this Bill and accept that medical discretion as now practised will, when necessary, humanely ease the road from life to death.
§ 6.41 p.m.
§ THE EARL OF HUNTINGDON
My Lords, as I think we all admit, this is a most difficult and controversial subject. The taking of life in any circumstances must make us all reflect very carefully. Recently, I happened to look at a television programme which dealt with cases of hopeless illness. Terrible cases of children who have no hope of survival were shown, but the case that has haunted me ever since was that of a girl of about 14 or 15, who had had a bad car accident, was rushed to hospital, where she was operated upon and her life was saved. So far as her lungs and heart were concerned, she was in perfect health again: but her brain was completely destroyed. A picture of this girl was shown, and the doctor was asked what was going to happen to her. He said that she might live a month or so, or for many years—he could not tell. But whatever happened, her brain could never be restored, and all that could be offered to her was a life in bed and being artificially fed through her veins. That is the sort of case which makes us wonder about euthanasia.
This Bill deals specifically with people who wish to have their lives terminated because of pain and of hopelessness as 1219 a result of having an incurable disease. I want to deal with what seems to me the only strong argument against the principle of the Bill. I do not want to go into the details, which I think should be altered a great deal in Committee, if the Bill gets a Second Reading. Many people have religious objections, that life must not be taken in any circumstances—though, as has been pointed out, exceptions are often made; in the case of self-defence or war, or even capital punishment; but I respect these convictions. It is to others who sympathise with the principle of euthanasia that I appeal.
I do not think there is much chance of members of the medical profession being bribed or suborned in this matter. I have a tremendously high opinion of the medical profession in this country. I could not admire them more for their work, their knowledge, their wisdom and their compassion, and one is reluctant to put more responsibility on them. But whether they like it or not, the responsibility of life and death is already in their hands. And in such modern instances as the small proportion of kidney machines in relation to the number of candidates who require them, or the scarcity of organs for transplantation, the doctors must face these professional problems. I think that these are ghastly decisions which they have to make.
One question that worries me is whether it would be possible for a patient to be encouraged by family or friends into thinking that he ought to ask for euthanasia, when, in his heart of hearts, he does not want it. That is the one formidable danger in the Bill. At the same time, I suggest that there are afeguards against such an abuse. One is the time factor. Such a decision cannot be rushed through It may be easy to persuade a person to come to a sudden decision, but a patient has to be made to stick to that decision for a month or longer which will be much more difficult. And there is a greater safeguard in the fact that many people are involved—the general practitioner, the witnesses, the doctors who decide who should be a qualified person. And, of course, one of the doctors has to be a consultant. I cannot believe that these people would not have had long talks with the patient, found out his or her 1220 state of mind, and would not have discovered whether some pressure had been brought upon him or her. I think that this is a real safeguard against possible abuse.
I was surprised to hear one noble Lord say that there have been so few requests for euthanasia but, thinking it over, I find that this is not surprising. People do not ask for something which they know is legally impossible. All they can ask for is additional drugs to relieve their pain. Many of your Lordships must know of people who have suffered severe pain. I do not wish to harrow your Lordships, but I should like to quote one case, because it brings out points that have been raised during the debate. It concerned a woman suffering cancer, who was in great pain for a long time. She was given quite a lot of drugs, but she was continually begging for more. But the doctor would not give her more for two reasons. He said, in the first place, that undoubtedly the pain would get more severe towards the end of her life, and that a residue of power had to be kept in the drugs to combat this pain when it came. I am not a medical man, and I stand to be corrected; but I understand that drugs lose their power if given excessively, and that therefore a reserve had to be kept. The doctor no doubt was also frightened (I think perhaps unduly so in this case) of giving too many drugs and ending the patient's life. This was an example which struck me as tragic, and which would have been alleviated by this Bill which, on the whole, would do a great deal of good. For that reason, I hope that your Lordships will give it a Second Reading.
§ 6.51 p.m.
§ LORD BALERNO
My Lords. I am grateful for the words of the noble Earl who has just sat down, because I think he illustrated the fact that there is no very distinct cleavage of opinion on this subject, as indeed the right reverend Prelate, the Bishop of Durham, indicated in part of his speech. For my part, I should like to take up the point that was made by the noble Earl, Lord Longford, when he said that life is sacred in the eyes of God. We are indeed concerned, as he said, with very deep mysteries, and it is that approach to life on which I wish to say a few words.
1221 As one who finds it barely credible that the human ovum at the moment of fertilisation acquires an immortal soul, so am I equally, and perhaps even more, incredulous of the proposition that the human soul invariably leaves the body with the last breath of life. I agree that often it is when the heart ceases to beat that the spirit returns to its Maker. But, to my thinking, there are cases where the human spirit no longer activates the body. In such an event, when both soul and mind have departed, there can, according to my lights, be no justification for keeping the body alive. Speaking only for myself, in such circumstances I should not wish to have my life prolonged unduly, rendering me altogether too dependent upon the care and attention of other people.
I know not how many there are who hold this view to be consistent with their Christian faith; but however small a minority we are, we surely have the right to ask those Christians who hold other views to show toleration of our belief and the consequences of our belief, so long as these consequences are not contrary to the public weal. Likewise I would plead for toleration of those who are not of the Christian faith—and there are many of them. Why should they, or we, when completely inert or chronically infirm and miserable be condemned to live? To-day, as the noble Earl, Lord Listowel, has said, we are discussing the principle of euthanasia. I trust your Lordships will give this Bill a Second Reading so that we may have the opportunity of examining with greater care the implications of the clauses, and will not condemn it out of hand, when there is, as this debate has disclosed, so much further evidence to consider.
§ 6.55 p.m.
§ LORD RITCHIE-CALDER
My Lords, I am grateful to the noble Lord, Lord Raglan, for introducing this Bill and giving your Lordships' House the opportunity to discuss this profoundly important subject. I personally will support the Bill, and I am grateful that I am following the noble Lord, Lord Balerno, who expressed so sincerely from the Christian point of view what I would maintain from my own point of view. In this matter, which is literally a matter of life and death, I have great respect for those who much search their 1222 consciences and their religious beliefs and who feel that life, even in a broken tabernacle, is sacred, and the many doctors who feel that euthanasia should be left to their compassion and discretion, although, as the law stands, mercy killing as it is now disclosed to be practised is murder and the doctors themselves are at hazard.
For myself I am perfectly clear that, in the words of the poet Seneca:As I would choose the ship to sail on, I would choose the manner of my going.And, like Peggotty in David Copperfield, I would go out with the tide when I felt like it. I am not a morbid person, and I am certainly not contemplating suicide from despair or desperation, but I hope and believe that my general practitioner (I have certain reservations about the objective observer hospital consultant applied by the Bill) would be my pilot on that topic.
Back in the 'thirties, in the days of Lord Moynihan, of Killick Millard and Mr. Justice McCardie, I was very closely associated with the Euthanasia Society. Although the death of Mr. Justice McCardie by suicide made me as a euthanasian pause, it raised the kind of question which my noble friend Lord Huntingdon raised. He was suffering from post-influenzal depression and thought he was useless, finished, through and discarded. But he would have thought quite differently 48 hours later. That is a consideration which every doctor has in mind. I may be a lapsed member of the Society, but not because I have disowned its intentions or its arguments, which I accepted when I was much younger, when I would not have been thinking about death. Then I was influenced by considerations which go far beyond the intentions of this Bill, and certainly beyond the burden of your Lordships' arguments—and the noble Lord. Lord Grenfell, has expressed these arguments most powerfully.
It arose from family circumstances, which sombrely coloured my whole young life. I had three aunts. The youngest was afflicted at the age of two by what must have been some kind of meningitis, which paralysed her, rendered her speechless and left her helpless, a slobbering creature without control of her bodily functions. Her mother, my grandmother, died when that child was four. One of 1223 my aunts, who was a very beautiful and vivacious woman, decided to devote her entire life to this younger sister. She broke off her engagement. There was a noble woman about whose glorious self-sacrifice the ministers in my home town preached sermons. But my other aunt was also sacrificed. She had to go out to work in the mills to earn the keep for the other two. Neither of those aunts ever married; and, in fact, no one could ever come around to the house because of this creature—and she was a creature. This creature lived for 60 years. She outlived her eldest sister, and left her other sister a twisted old woman. My childhood memory, which coloured the whole of my attitude to this question, is of an animal screeching and of an ogress. Fear went far beyond my pity. From there on I had no pity for this kind of creature. The only pity I felt thereafter until now was for my other aunts who sacrified their lives and their happiness. I could not, even with respect to life, feel that two lives should be sacrificed for one.
I know that some of your Lordships will feel abhorrence—indeed, the noble Lord, Lord Grenfell, has expressed abhorrence—at the suggestion that medicine would have been, or could have been, more merciful if she had not lived. But I would ask your Lordships to take some account not only of the profound question that we have been discussing to-day—and it is very profound. It is the greatest and most deep in all human philosophies, whether one is an Agnostic like myself, or a Christian. It is the most important question we are discussing. But do, please, my Lords, take some account of human dignity and in any devout belief in the sacredness of human life have some concern for the dignity and the personality of the life that is being preserved, and the indignities and the sacrifices which others have to make in preserving that life. To me it is a mockery, a mockery of everything which is in the nature of man, that we should in fact, under the conditions in which we are trying to prescribe what in fact is the nature of life, bedamn the living and condemn people to a death in life.
Whatever your Lordships decide to do about this Bill, you will at some 1224 time—and the sooner, the better; and so far as I am concerned we shall be brought back to it in some circumstances—have to consider not only what we are discussing to-day; you will have to consider the new factors which science has introduced into the whole estimation of what we are discussing to-day. The noble Lord, Lord Platt, has made this very clear. He could not have made it clearer; he could not have said it more completely, and it could not have been said, if I may say so, more beautifully than the noble Lord, Lord Soper, has said it. How are we going in fact to estimate the meaning of life? We cannot even do it scientifically. We have to take an encephalograph to find out whether a person is alive or dead.
At this point I ask your Lordships very seriously to consider what in fact it is that at this moment we are considering; what responsibility we are throwing on the doctors as to the decisions they must make about helping somebody in misery and in suffering out of life. But let us ask ourselves, and seriously ask ourselves, what the medical profession in its ultimate meaning and contribution is doing in quite a different kind of way. Lord Platt made this point clear, and others have raised it, too. I ask your Lordships seriously—I repeat, seriously—to consider that we are in fact making a travesty of the living. I am not considering now just the pain and the misery. I am considering what we are doing to people whom you and I know; and I am speaking now with deep concern and very great and deep affection for many people whom I have seen go through this condition of being artificially kept alive as creatures they would not have wanted to be.
We are now in this age of bioengineering. We are now capable of transplanting human organs. We are capable of surgical plumbing. We are capable of doing what was reported in last week's British Medical Journal as the last stop-press of medical discovery. To every doctor we give the responsibility of his Hippocratic Oath, which I respect—and I respect everyone who has invoked it here. But if we give him the responsibility of his Hippocratic Oath he must take his latest knowledge and give it to his patient, whether the patient wants it or not. This is a tremendous responsibility which is now becoming the human 1225 artefact: the person who is being composted, created by medical science. I ask your Lordships this question seriously, very seriously. I am not being extravagant. If one follows through what is happening to-day, if one takes the meaning of surgical plumbing, of the transplant, what is being transplanted? What is being kept alive? You can eventually finish up with somebody who is a spare-part creation: he has the liver of somebody; he has the kidney of somebody; he could even have the heart and lungs of somebody—to keep alive what? A being? No. What is being kept alive, by any definition which is left to us (because we have only the encephalograph to tell us what is living and what is dead) is a brain. And the brain is not the mind; it is not the personality. The brain is a biological computer. The mind, the personality, is something more. It is a complete being. It is your metabolism—what you ate for breakfast this morning. It is your endocrinal glands; it is your memory; it is everything else. It is what goes into being the being that you think you are.
By no stretch of my imagination would I ever imagine being kept alive by this method. I reject it completely. I have a human right. I notice that in another House one of the Members is invoking opposition to this Bill on the basis of human rights. I am asking your Lordships for support of this Bill on the basis of human rights. I believe in human dignity. We have a right to dignity. And this is basically what we are discussing. We get to this situation, which I have seen; we all have seen it. I think now of very eminent people with whom I have been associated who have been kept artificially alive because they were eminent people. They might just as well have been embalmed, but they were living when they were not really here.
Here we have a problem which has been raised by the noble Earl, Lord Huntingdon, and it is this. Take one simple illustration. If you have a kidney machine—and kidney machines are in short supply—to whom do you give the use of that kidney machine? There is an eminent person, perhaps a Member of your Lordships' House or a Nobel Prizewinner—I do not care who he is, but he is eminent—and he has a right, almost a prescriptive right, to that machine be- 1226 cause he is old and because he is dignified. And there is a youngster of 15. We do not even know whether he is going to be a juvenile delinquent or is a potential criminal, but he might be a Nobel Prizewinner. But the choice, believe me, in this "playing at God" in the medical profession, I swear to you, will go to the eminent, the aged eminent. This is the choice that we are already making, and at this stage I sincerely ask your Lordships, in considering this Bill, not only to consider its details (we can argue them out in Committee) but to consider the implication of this situation, which goes far beyond just the question of whether we are going to give someone an additional shot of morphine, which is the old measurement of this. We are talking now about choices doctors have to make, that we have to make, in going forward to create "zombies" and "vegetables". I thank your Lordships very much.
§ 7.9 p.m.
My Lords, I feel that I must begin with an apology for being very contradictory. I heartily oppose this Bill in every way, yet if I were given the choice I should moat certainly take every advantage in putting down these children who are born absolutely crippled and wrong. I am also in favour of the death penalty on capital offences. Having said that, I must confess that I have very little medical knowledge. My medical knowledge has been confined to a certain amount of work in Africa, on plantations, before people there could be taken to hospitals and suchlike. I have every confidence in the medical profession, and I have owed them a very great debt of gratitude on several occasions. Nevertheless, I think all your Lordships will agree that the medical profession is not infallible.
I have known cases when operations have been performed and they have been perfectly useless. I have a great friend who, before the First World War, came to me in Africa under sentence of death. He was given eighteen months to live. That was in 1913. In 1915 he came back to this country, he managed to "wangle" himself into the Royal Flying Corps; he was decorated in this country; he was decorated by the Imperial Court of Russia, and he is very much alive to-day. I know that since then we have made 1227 great medical strides, and I personally have tremendous confidence in our medical profession.
I have not a great deal of confidence in Clauses 5 and 6 of this Bill, but that does not particularly worry me because I have always remembered some words of an old song of the music halls of the Edwardian period, "We came into this world with nothing on, and we can't take anything out". I think perhaps those words are very suitable to-day, when one thinks of it. But surely the whole of this question could be put into a nutshell—into eight syllables of the English language: "Man proposes, God disposes". The Germans put it better still; they put it in four syllables, Mann denkt, Gott lenkt. That, I think, is the key to the whole situation. Are you prepared to take a step in your own life, or in the lives of other people; or are you prepared to do something which you are not supposed to do? Surely we have all been put into this world to do a certain job; we admit that we can do nothing without the help of God; and, finally, it is God who makes the decision and not we ourselves.
I consider that if this Bill were carried through it would be a most dangerous thing, because it begins by taking away the responsibility; and you are going to decide and to make the determination whether you have the right to end your own life or the life of anybody else. I ask your Lordships, if it really came to the point, supposing you had a relation or a friend who you knew had a fatal illness and could not live, and who you knew was suffering greatly, would it not require a great deal of courage, a great deal of determination, to sign on the dotted line and to give his death sentence? I do not believe that you would do it, my Lords. I would not do it for one moment. The alternative—what I would do, and what I am sure most of your Lordships would do—would be to pray to the Almighty God that He, in His bountiful mercy, would with all speed give to your loved onethat peace which the world cannot give, and which passeth all understanding.And I, as a humble Christian, am sure in my own mind that your prayers would not be in vain.
§ 7.16 p.m.
§ BARONESS SUMMERSKILL
My Lords, I do not question the sincerity and the good faith of my noble friend and those who helped him to draft this Bill, but I think that what they have lacked—and I am afraid this sounds a little presumptuous—is some advice from people like my noble friend and colleague, Lord Brock, who I thought made an excellent speech. The point is that this is a matter which cannot be thought of in theoretical terms. It requires close knowledge of death, of the sick room, of suffering, of human nature when faced with all these problems as to whether life is worth living and whether one should weigh up those things that make it worth living or going on with for a little longer—these are the human problems which must be considered when you are drafting a Bill of this kind.
I am not going to deal with some of the technicalities because I must admit that some of them seem a little naïve in their presumptions. I just want to deal generally with some aspects that have struck me. There is a feeling among young people who are "with it" to-day—and we were all "with it" at some time and longing to do something different from our elders—that no individual should be denied the right to release himself from the pain and distress of an incurable disease. On the face of it, that is unanswerable. Well, every individual has that right. In 1961 the law permitted any individual who found life intolerable to take his own life, and of course in those circumstances that is quite right; but that decision involves that person alone. This Bill, dealing with enthanasia, is a different matter. It involves not only the patient and those instructed to take his life but—and this is the point I am going to make this evening—also every other person in the country suffering from some incurable disease.
If your Lordships will forgive me for saying so, I come from a large medical family. I was qualified at 25. My father was a doctor, my husband is a doctor, my daughter is a doctor and I have a number of nephews who are doctors. Naturally we discuss these matters and it is a curious thing that in my medical life never once have I been requested by a 1229 seriously ill patient to give him an overdose. Why is that? The noble Lord, Lord Amulree, emphasised the point that although life may be painful, physically and mentally, although one may get a little weary, nevertheless life is sweet, and there is no positive indication that as life goes on and becomes more painful the individual wants to be destroyed. I must confess that I sometimes wonder just where the demand for this Bill has come from. Is this a great omission in our National Health Service? I have to confess that those of us who were planning the Health Service in the early 1930s did not give any attention to euthanasia; we were much more concerned with the question of conserving life.
According to this Bill, the individual who signs a declaration must be sane. I can only say that a patient suffering from some chronic complaint is not lucid and in full possession of all his faculties, although he may not be mentally ill. Most people are not supermen and they become childlike as they lie and watch a wife or some other near relation toil day and night at tasks which can be uncongenial in the sick room and even repugnant to a person not trained in nursing. This Bill presupposes that this patient, completely lucid, will watch this and then decide to make a declaration; that he will sum up the position, ask for a pen and paper and arrange for his despatch after 30 days have elapsed. I am trying to bring this Bill into the sickroom. In the first place, who is going to tell him that he is going to die? This is a very interesting point. I have never met any doctor who tells his patient that he is doomed and in consequence deprives him of the most comforting assurance, that of hope. Who, first of all, is going to tell him he is doomed in order to set this rather macabre machinery into operation? Of course, we know the relatives are often told; but as the declaration for euthanasia can only be signed by the patient, it must be left to a relative, perhaps with ulterior motive, to remind the sick man of the availability of euthanasia and the part that he must play in the initial stages.
Two doctors have to certify that the sick man is incurable; and, by the way, it seems to me a most curious thing that two strangers in a hospital must certify that he is incurable and one of those undertake the delivering of the coup de grace. But 1230 the general practitioner, who may have brought him into the world, who may have been with him through all the problems of his family, may have nothing to do with his ending. I shall come to that point in a minute. If two consultants have to be invited to pronounce on him, this, of course, can be done by friends who can arrange these preliminaries. Then the stage is set, and any time after the next 30 days the lethal dose can be given, provided, of course, that the patient signs the declaration.
But the instinct of self-preservation is the strongest in all of us. Who has ever heard of a patient with cancer, on leaving, let us say, the out-patient department of one of our big voluntary hospitals, deliberately running under a lorry in order to end his pain? His instinct when he comes out of the out-patients department, although he knows he has cancer, is to jump out of the way, as quickly as a healthy man if he can, such is the instinct of self-preservation. Therefore, my Lords, I very much doubt that this man in the first place will do as expected of him and sign the declaration unless legislation of this kind is put on the Statute Book and it is brought to his notice by somebody.
Of course, there are patients surrounded with loving care, where there is ample help available and where the inconveniences associated with chronic sickness are minimal. But this picture of the sick room is far from universal. Some illnesses involve so much hard work that those in attendance day and night soon show signs of fatigue; and I think the demands on our hospital accommodation provide ample evidence of the problems of the sick and aged in our society. That is the background that doctors see every day of their lives. If euthanasia becomes the law of the land every overcrowded family will be familiar with the terms of the Act, and undoubtedly there will be somebody to remind the invalid of his newly acquired powers over his own disposal. That is an additional horror that can be inflicted by these provisions on all people suffering from an incurable disease.
It may be said, and I think it is true, that perhaps a tiny minority may opt for dismissal; but the majority, with a strong instinct to survive, will suffer intensely from the knowledge that they 1231 could, if they wished, relieve their relations of a burden. The patient may even discover that the family is divided, some wanting to press him to sign the declaration and others against it. It is no good the noble Lord telling me that two signatures are necessary from people who will declare that there has been no pressure. In overcrowded homes pressures can be unspoken; there is no need for somebody to go up and say, "Sign a declaration". There is the old person in a room which is desperately needed by the older children. Therefore this part of the Bill which provides for signatures from people who will declare there has been no pressure is of course nonsense; it is completely unrealistic.
This individual who feels that he is unwanted may soon develop a sense of guilt and may freely respond and offer to sign his own death sentence. But one day, feeling a little better, he will revoke his declaration. That is all provided for in the Bill. Then all the horror of subtle persuasion and a possible further revocation begins again. However, let us assume that he finally signs his declaration. Then he is subject to a new form of mental torture as he waits for the lethal dose.
The Bill provides for the doctor or the nurse to administer the dose. The nurse, perhaps a young woman of 21 who has just become qualified, who went into nursing because she had a big heart, she had compassion, though nevertheless society has always exploited her, given her long hours and low pay—she is to be chosen in this Bill as an executioner. My Lords, who could have been so unthinking as to put that into this Bill? If one or both, the doctor and the nurse, at the last moment, refuse to give the lethal dose, there will be a gruesome search for replacements. Why have the doctor and the nurse been chosen? The administration of the lethal dose will not call for any particular expertise. During the patient's illness many unqualified people have given him medicine, and given him quite possibly an injection. Surely the final act is one which should be performed by someone whose hand would not be infirm of purpose.
I am not being unkind—I am sorry my noble friend is not here—but I thought, if this Bill becomes an Act, who 1232 are qualified to be the executioners? I can think only of people who are dedicated to this particular cause. Therefore, could not the officers of the Euthanasia Society provide a small squad for what is in their opinion a humane function? I have to confess I then looked up the names of the officers, and I found that the Chairman of Committees of this House is the President of the Euthanasia Society. But why not? If you feel that this is what society needs, if you feel that we have been remiss and that we should provide people to kill off the unwanted and the sick, then you should not be squeamish: you should not say, "This hand will not hold the dagger". Therefore, if it becomes law we shall, at the Committee stage, have to look very carefully and see whether the Bill can be amended along the lines I have suggested.
And no doubt if it became law there may be a statutory method adopted for killing a patient as expeditiously as possible. That seems to me logical. If you decide to kill, surely you will decide which is the kindest and nicest method. Here we hanged, but in the United States they have decided to kill their criminals with an electric chair. If we pass a measure which will provide for the killing off of patients, then certainly we must be as humane as possible, and we may need to have a discussion here as to what is the most expeditious way. I have no doubt that there will be a lot of legal cases, because doctors or the members of the Society who are to do the killing will be charged with not using the right methods. Therefore we shall have the most interesting legal discussions. I should also like to know what will be the certified cause of death in these cases. If morphia is used, then while cancer may be a contributory cause the immediate cause will be morphia poisoning. The death certificate provides space for all the relevant details, and these are expected to be supplied in full on it. This is an important practical problem, and I hope that my noble friend who introduced the Bill will provide the information.
So, finally, I would ask those who have supported this measure whether, having heard this debate and having considered the whole question again, they really feel that these provisions are more conducive to a civilised way of life, or whether they represent a reversion to a more primitive 1233 existence in which those who have outgrown their usefulness to the community should be despatched as painlessly as possible.
§ 7.32 p.m.
My Lords, in following the noble Baroness, Lady Summerskill, I should like to pay tribute to her speech, which I found most interesting. It seemed to say so many of the things which I believe many noble Lords must think; yet it said them in a way which everyone could understand and appreciate. I am bound to say at the outset that I am an opponent of this Bill for two basic reasons. One is that I disagree in principle with euthanasia, and the other (and this by no means suggests that it is more important) is that, if accepted, the principle of voluntary euthanasia will in time give way to a more general and less restricted application of the practice.
The great attraction of this Bill, or of the principle of this Bill, is that it appeals, among other things, to the emotional side of people—and I do not mean that in any derogatory sense. It appeals to the kindliness, to the generosity, to the sympathy and even, in some cases, to the humanity of people. To those who might normally be opposed to euthanasia, this Bill, or one like it, has the greatest chance of all of being able to persuade them that, after all, there is a case for an exception. We are obliged to conjure up in our minds the sight of people, probably aged, suffering from a terminal disease, or suffering acute ravages of agony. The thought, as is the fact, is most unacceptable. Yet here in this Bill we are given the chance of relieving them of their agony or, more strictly, of permitting the people themselves to ensure that they may be relieved of their agony.
No one, my Lords, could fail to be disturbed at the thought of such suffering, and I can well understand the sentiments of those who feel that they will be doing a service, either to the sufferer or to humanity, or to both, by allowing the person, at his discretion, to bring forward the date of his inevitable death. But such a rigorous variation of our code of life requires one to look deeper than that. We cannot, I suggest, legislate for the really hard cases, strong as indeed their case may be. We must see what will, or can be, the effect of this law on society as a whole.
1234 I believe that we should be fundamentally wrong to condone the termination of, and to permit members of society to terminate, the lives of others, even within certain defined limits. If one permits life to be so extinguished, one debases, I suggest, the value of human life, and probably debases also the value of the spiritual attainments which one likes to think the human has over the other species. But even if one were to take the view that in these cases of people suffering from an incurable and agonisingly painful disease, disease which can end only in death, one should be permitted to take the more lenient and considerate view, I should be against this Bill, but for a different reason. I think that the pressures that would be put upon people suffering from these ailments would, as the noble Baroness has said, be considerable, unjustifiable, and in some cases, quite intolerable.
There are two types of pressure. There is the active and there is the passive pressure. When people are old and ill they are entirely dependent upon the people around them who look after them. They become dependent upon them, not just for their physical wellbeing and for their needs, but also for their advice, their help, their encouragement and their moral support. It does not need a fund of imagination to envisage an unscrupulous person suggesting to an invalid that he or she takes advantage of the facilities which are now offered to them by this Bill.
This might not be done in a coarse manner such as one might readily imagine, but could well be done out of a genuine desire to try to help. But, of course, it is but one step further down the road of permissiveness or unscrupulousness to see people wanting an aged relative out of the light because they would be relieved of the worry of looking after him or her, and might possibly be financially better off as a result of the death. There would be all sorts of ways, entirely legal and above board, of bringing to the attention of the person in question the possibilities which this Bill contains for him or her. The noble Lord, Lord Raglan, may say that the Bill takes care of the unscrupulous. I simply do not believe it. It takes care of the unscrupulous who act in an unscrupulous 1235 way, but it does not take care of the unscrupulous who act in a scrupulous way. These are the active and more obvious pressures, but they are none the less important for that.
Then what about the passive pressures? Let us for a moment consider a person aged and suffering when a Bill such as this passes into law, a person who does not need to take advantage of its provisions but who yet feels that he or she ought to. Can one not envisage a person who knows that he requires looking after, who knows that he is a liability on those who tend him, feeling, "I know that I am a liability. I know that I create work. I know that I am a desperate tie on my relatives. It would be much easier for all if I were out of the way. I do not want to die but in the interests of others I feel that I ought to."? What a horrible situation, and what an intolerable pressure to put upon anyone, least of all one who is aged and infirm! Or, if one takes the matter a stage further, one can visualise a person thinking, quite erroneously, that the relatives would be happier with him or her out of the way, and then taking advantage of the provisions of this Bill, to the considerable distress and unhappiness of his relatives and friends.
My Lords, we should be reducing human life, and indeed humanity, to a level of which in my judgment we should not be greatly proud if we permitted the termination of life only at the discretion of an individual and performed by another. I fully see the force of the argument that points to the misery and pain created by disease and illness, and that a service would be done if we were to try to alleviate such cases. But your Lordships know only too well the saying that "hard cases make bad law". I believe that in this instance the cases are hard, but I believe that the law, if we did as is suggested, would be bad.
In considering this Bill, I was reminded of something which the noble Lord, Lord Fisher of Canterbury, I think once said; namely, that there is no unreasonable argument that cannot be proved reasonable by reason. I think that we have seen the protagonists for this Bill use reason in presenting their case. They have made the argument look reason- 1236 able, but I believe that, though understandable, it is fundamentally unreasonable. I believe that we should be quite wrong to accept this Bill, and I, for one, shall vote against it.
§ 7.40 p.m.
My Lords, not for the first time I find myself in a difficult position talking at this time of the evening. I do not want to keep your Lordships from the vote, but I have a number of things that I very much want to say. When it comes to the vote, I am going to be in the unusual position, for me, on a question like this, of going into the Lobby with a great many noble Lords who have spoken. One way in which I could shorten my speech would be to say how enormously I have agreed with the things that have been said. I should then have to read out a list of speakers after the noble Earl, Lord Cork and Orrery, including the noble Baroness, Lady Serota; the noble Lord, Lord Brock; the right reverend Prelate the Bishop of Durham; the noble Earl, Lord Longford; the noble Viscount, Lord Waverley—the last two speakers in particular; and I will leave out many in between.
As so often happens, it seems to me this debate has strayed from what I thought it was originally. I understood that we were going to debate the Amendment to the Bill for voluntary euthanasia. It has now become a question of whether we should give a Second Reading to the Bill with the idea of amending it later; whether we should introduce another Bill later dealing with involuntary euthanasia; or even, in the words of the noble Lord, Lord Ritchie-Calder, whether one would have to have a new word which meant nothing to do with the taking of life at all.
For that reason, the few things I have to say I shall try to confine entirely to the Title. I had better summarise them quickly by saying that if this is a question of voting for a Bill, or any Bill, for voluntary euthanasia, I would support the noble Earl, Lord Cork and Orrery, because it has been proved to me by all the speeches made by those who know about it, to my mind beyond any possible argument, that it is not practical, it would not be possible. I do not want to repeat what was said by the noble Baroness, Lady Summerskill, and others as to the difficulties of enforcing voluntary 1237 euthanasia. If it is a question of the principle of euthanasia—which many people have talked about—including compulsory euthanasia, I would be against it because I think it is wicked.
I think I can save your Lordships' time by touching on only two subjects. One was brought up by the noble Earl, Lord Listowel, when he referred to the "slippery slope". It was suggested that that is something we should not be discussing because we are merely discussing this Bill. I should have more confidence in that argument if there had not been other Bills which we have discussed recently and which have made me very anxious about legislation of this kind. One has been mentioned by many of your Lordships, the Abortion Act.
I am possibly prejudiced on that subject, but I should like to read, if I may, an extract from a letter from the President of the Royal College of Obstetricians and Gynæcologists on the subject of that Act, which I think is relevant because it shows how far that Act has gone since it was passed. It was in a letter to the Guardian on February 18, in answer to an article which had suggested that doctors ought to carry out abortion virtually on demand. I will read only two paragraphs. Sir John Peel writes, among other things:Your readers will recollect that during the debates on the Bill"—that is the Abortion Reform Bill—in its passage through Parliament its sponsors and supporters declared repeatedly that the object of the Bill was not in fact 'abortion on demand'. Since the Bill passed through Parliament expert legal opinion has been given that the Bill does not in fact create abortion on demand.In spite of your insinuation to the contrary, the majority of Fellows and members of this College "—that is the College of Obstetricians and Gynæcologists—are trying conscientiously to interpret what the Act says is legal, and not necessarily what the public seems to imagine is allowed. It would be well for the public to appreciate more fully that abortion outside the terms laid down in the Act is still a criminal act, and surely it is the role of responsible journalism to clarify the difference between the facts of law and the public's interpretation of them.If in fact the object of the Act was the establishment of an N.H.S. 'abortion on demand' service, as your leader implies, then indeed the sponsors of the Bill were guilty of 1238 misleading both Parliament and the public in the most shameful way. To state with approval that independence of clinical judgment is the cornerstone of medical practice, and then to suggest that because consultants are the servants of society they must accede to the 'demands' of their patients in the matter of abortion, is utterly contradictory.That suggests to me that a great many people, and some very reputable newspapers, are now attacking doctors for not carrying out the law, and suggesting that they should be, as the noble Baroness put it, executioners. In answer to her question: "If one is going to have execution, who should do it?", I think it is possible to argue that if one carries far enough the slogan that the function of a Government is to govern, then the function of an Executive can very easily become to execute.
I believe that this is one of the few Bills in your Lordships' House which is quite incapable of being amended. I can suggest only two Amendments. One would be to make the title "Involuntary Euthanasia", because I believe that is the only kind that is possible. However, that would mean amending the Bill. The other Amendment might be thought frivolous. There is a paragraph to the effect that the qualified patient—and in this case "qualified", rather unusually, means "having agreed to"—must be of the age of majority. I think there would be a case in this Bill for raising the age of majority. I will not say, as the noble Viscount, Lord Montgomery of Alamein, once suggested, that it should be raised to the age of 80; I think raising it to 180 would be the only way that I would feel that this Bill could go through.
My Lords, the noble Lord, Lord Archibald, said that he was not going to discuss this subject on a highly religious plane. He gave a very moving and graphic account of his experience with his mother. I appreciate that, because my own mother was twice ill in her life. Once she had a depression when she wanted to commit suicide. I am very glad indeed to say that she did not, because she lived a happy life after that. But after a vigorous and energetic life she was dying of cancer—this was quite a long time ago—and it was decided that she was incurable. I was asked by our family doctor, who knew her and us, what was my opinion about their continuing to inject her to keep her out 1239 of pain. They would have to increase the dose, and this might or might not shorten her life. I had no hesitation at all in saying, on behalf of my father who disliked talking about those things, "Keep her out of pain if you can." That is quite a different thing from killing her. It would have been a quite different matter if they had said to me, "Shall we give her something which will kill her straight away?"
I am not being sentimental about this matter, because a great deal depends on what one sees. But I believe that the worst thing about the Bill, if it came into force, would be the strain which it would put on doctors and upon medical attendants. Surely they have quite enough strain of that sort already. A few days ago I was talking to a eminent gynæcologist who is in hospital with a serious illness of the heart. He told me of an incident in the last six months involving a hospital attendant, a porter, who after a legal abortion operation was carrying a baby with instructions to put it in the incinerator. It cried so vigorously that he felt he could not do it. He took it to the pediatric ward and I understand that it died after a day and a half. That is the kind of thing which people have to put up with—and nobody is blaming anyone for that—if laws are passed which involve these difficult decisions. I do not know what the man's duty should have been. I believe that the case is under consideration by the Procurator Fiscal.
Bills of this kind can come in only on the assumption, which is made throughout this Bill, that euthanasia (which in Greek means a good death) means a comfortable, easy death—in fact, the sort of death we all want. Most of us know that doctors will try to give us that, if they can legitimately do so. Therefore it is unnecessary to alter the law in that respect. It is a different matter if it means precipitating death. As the noble Baroness said, we must make up our minds whether we want to put out of the way anybody who may be inconvenient, unhappy or maladjusted in any way. It would certainly be most difficult to know where to stop.
I do not like to introduce a religious note from a lay Bench, but such a note has been introduced by other speakers, 1240 particularly by the noble Lord, Lord Ailwyn, who in a moving speech invoked St. Paul to suggest that charity could include killing somebody for his or her own good. Speaking as a layman, I think it is interesting that we were discussing in Advent the Abortion Act which would have made out a good case for preventing Christ from being born. The present Bill, which we are discussing in Lent, assumes, without argument, that a good death and a painless death are necessarily the same. I believe this to be a dangerous fallacy. I believe that a doctor's business is to make death easy, if possible, but not to precipitate it.
The answer to people who ask, "What is a human being?" must be a dogmatic one. The agnostic answer about life and death was given well by Socrates at the end of a long speech in which the noble Lord, Lord Soper, would say he committed suicide, because he invited death. His concluding words were: "This case is finished, discussed. We must go our way, you to life and I to death—and which is the best only God knows". That is all that can be said from the agnostic point of view.
I have a feeling that the right definition of a human being is on the lines of the reply given by an Irish M.P. who, when asked to define a country, said that it was something a man would die for, adding, "Not even the honourable Member would die for the Meridian of Greenwich". A human being, to me, is someone for whom Christ died and who went through the same experiences as Christ is said in history to have gone through: being a child in the womb before birth, living in a body, and dying. In regard to any sort of artificial human being, made out of who knows how many clinical elements, in goodness knows how many test tubes in the future, I shall be open to conviction as to how he could be treated. I feel that it will be much more like—I say this in the kindest way—the way an animal is treated. Human beings, both on agnostic and Christian grounds, have a right to life with which nobody, and least of all doctors, should be ordered to interfere.
§ 7.58 p.m.
§ LORD STRABOLGI
My Lords, I support the Amendment which was so 1241 ably moved by the noble Earl, Lord Cork and Orrery. My noble friend Lord Raglan was right to introduce this Bill, which has given rise to an interesting debate. I pay tribute to him for the able, sincere and moving way in which he moved the Second Reading. But however well-intentioned the Bill may be, I feel sure that it will open the way to many abuses. I am the Honorary President of Aegis and I am most concerned about the Bill's implications. We have much evidence that elderly people often become confused, and indeed they could sign their own lives away without being fully aware of the consequences. There is grave danger also that patients would become prey to unscrupulous people over the form of declaration. A patient might be killed by a doctor in good faith as a result of a forged declaration. Here I agree with the noble Earl, Lord Ferrers. It would be impossible for courts to discover the truth, for the patient—the chief witness—would be dead. Possibly any witnesses, if they ever existed, might not be found or might themselves have died. There would therefore be no way in which the court could arrive at the truth. This was another argument, and a very strong one, which was often adduced against the death penalty and is a point of view which, paradoxically, seems to be held by those who support this Bill.
My other reason for supporting the Amendment is that the Bill creates a dangerous precedent; and on this point I listened with great interest to what my noble friend Lord Listowel said. I am absolutely certain that it could lead to the authorised killing of lunatics, or those who were hopelessly deformed, or, eventually, anybody whom somebody or some wicked Government decided was not wanted and should be done away with. In my view, this Bill is the first step on the road to Auschwitz, and I hope the House will turn back and reject it.
§ 8.1 p.m.
THE LORD BISHOP OF EXETER
My Lords, I am sure we are all agreed that this has been a most valuable and interesting debate, and we are indeed grateful to the noble Lord, Lord Raglan, for having brought it about. But perhaps the debate has gone on long enough, so I shall confine myself to making just two points: to reiterate one which has been made often 1242 enough, and to make another which has has not been stressed quite so much.
There is no doubt whatever that this Bill for voluntary euthanasia is by legislation out of compassion, and there can be no question but that the compassion which has borne this Bill is utterly genuine and sincere. And yet the principle underlying the Bill is that of admitted assisted suicide, while the overwhelming weight of Christian tradition over centuries is against both suicide and assisted suicide; and not only the tradition of the Christian religion, but, as I understand it, also of the Jewish religion, the Moslem religion and, indeed, of most communities in the human race. This principle of opposition to suicide or assisted suicide rests upon a conviction of the sanctity of human life, respect for human life, the value of human life—call it what you will. So we must be extremely careful and sure of ourselves before we make any breach in that principle.
Breaches have been made, rightly or wrongly, by the Christian churches in the matter of killing in war and in the matter of capital punishment for crime. But I do not think that because of that we ought to make any further inroads into this conviction of the respect and value due to human life. To kill out of compassion is a curious paradox, and the complexities, the problems, the difficulties which we should run into if we were to allow this have been amply demonstrated to your Lordships in the course of this debate, so I shall not recapitulate them. I shall only say again that I believe it to be a matter wherein we should move, with the most extreme caution, when we attempt to make an inroad into a principle which has been upheld by the Christian churches and the Christian religion for centuries and which is also upheld by the greater part of the human race. That is my first point.
My second point is this. While I do not for one moment question the sincerity of the compassion which has brought this Bill on to the Floor of your Lordships' House, I would say that there are many ways in which compassion can show itself. It not infrequently happens that the compassion which seeks to relieve the suffering of a few ends by causing far more suffering than it relieves. I believe that the supporters of the Bill grossly underestimate the fear or anxiety 1243 with which older people, and especially the older, not-so-well-educated people, approach old age and death. Already they are anxious and afraid as the moment draws near when they know they will have to go into an old people's home or a geriatric ward or hospital. They ask: what will they do to me when I go? They are bewildered. Already they have a suspicion that once they get in they will never get out, except to the churchyard, and that earlier, they think, than necessary.
I am quite sure that the effect of this Bill, if it ever reached the Statute Book, would be to be interpreted by those simple people as being an authorisation to the doctors and nurses to put an end to their lives when it was thought right. I quite agree that this fear and anxiety would be entirely unjustified by this Bill, but that is how I think the Bill would be interpreted by ordinary, simple elderly people who feel themselves helpless, in a way unwanted, for one reason or another forced to go into a home or a hospital. This Bill will increase their fear and anxiety, so that they will spend the last years or months of their lives in a really distressing condition of fear, of never knowing, of never trusting those who look after them.
So I think that the compassion which has inspired this Bill would be better replaced by compassion for the millions of elderly people who are already in some fear and anxiety, and that the true compassion is to press for further research into drugs and pain-controlling analgesics, and for more money to be spent to improve both the staffing and the conditions of geriatric homes and hospitals. That is the true expression of the compassion which we all feel for the old and the incurably ill: not to allow them, with the help of a doctor, to kill themselves, but to provide for them the conditions and the circumstances which will make their lives bearable, so that they can die in peace and in dignity. Therefore, my Lords, as I think this Bill is altogether a wrong expression of the compassion which we all feel, I shall vote for the Amendment.
§ 8.10 p.m.
§ LORD SEGAL
My Lords, anyone who is at all conscious of the fallability of human judgment, especially in matters 1244 affecting life and death, must feel how difficult it is to vote in favour of this Bill. Especially in this House, where we are used to legislating largely on the basis of known facts, how difficult must it be for us to embark upon legislation into the realms of the unknown. Parliament has already passed an Act abolishing capital punishment, and here we are asked to pass a Bill legalising the capital sentence upon those who are ill or stricken or in pain.
The other curious feature of this debate is that there has been no insistent demand for euthanasia coming from doctors, although this Bill sets out ostensibly to protect their interests. The demand for euthanasia is almost entirely from the one side, on behalf of the patients. Of course doctors must, at some time or other in the course of their experience, have to decide whether or not they are in favour of mercy killing; but they are, so far as I am aware, content to continue to tend their patients under the existing sanctions.
I well remember, as a young assistant some forty years ago, having to decide on my first case of mercy killing. For three days a young mother had been going through her first labour and was desperately longing for her child.Thebaby's head was impacted in her pelvis and it was far too late to perform a caesarean operation. It was a choice between her life and that of the child. The chief obstetrician of a large London hospital was called, and he decided to sacrifice the child. When the operation was over, I was left in charge of a straightforward labour, to deliver what he had made sure would be a dead child. But after a mass of broken cranial and cerebral tissue emerged, the head was born, and to everyone's horror the macerated fœtus began to cry. There were six or seven student nurses all round, and each and every one of us was equally horrified. The mother would soon come out of her anesthetic and demand to see her baby. All I could do was to ask the labour ward sister to supervise the third stage, and to undertake to bathe the baby myself. I asked a nurse to keep on adding a few more extra jugfuls of warm water to the bath, and immersed the baby head first. I suppose they could have laid an accusation against me of wilful murder, or at least of infanticide, but luckily the 1245 nurses all understood and, after their initial dismay, they acquiesced in what was done. That was over forty years ago, and in the same circumstances I would do the same again to-day.
At the other end of the scale, I remember the case of an old man of 82 with a massive cerebral haemorrhage. He lay in a deep coma for two weeks, and consultants had agreed there was no hope of his recovery. I remember deliberating to myself whether or not to hasten the end, and finally decided to inject twice the lethal dose of a certain drug. It had no effect at all. Then I gave four times, then eight times the lethal dose, but still he went on persisting in a deep coma. I felt as if there was some higher force deciding his fate beyond the power of the drug, and decided there and then to allow him to die without further medical intervention.
So often the greatest of specialists are fallible in their judgments. Even Clause 8 of this Bill, which seeks to lay down an entitlement to drugs, can often be at variance with medical experience. I remember a patient in her early forties in the terminal stages of cancer—a brilliant artist, the beauty of whose features were masked by the lines of her suffering. She knew she was shortly to die, and needed twice-daily injections of a pain-killing drug. One morning, as she lay on her death-bed in her studio, she began to talk of her paintings on the walls, and to my surprise after a while she said, "The pain seems mach easier now; I do not think I shall need my injection after all". So there is also a limit to the patient's entitlement to lethal drugs, which the doctor, if he is wise, will always administer with caution.
As one closely connected with the work of the National Society for Mentally Handicapped Children, I have heard of no insistent demand for euthanasia or mercy killing on the part of any of the parents, who often have to carry the heavy burden of caring for these children for the greater part of their lives. Sometimes, on the contrary, these parents speak of the depths of love and affection which they receive from the children in return. I have often been dubious about those lines of Robert Louis Stevenson:Glad did I live and gladly die,And I laid me down with a will".1246 He was dying of tuberculosis on an island in the Pacific, in his early forties. Had he been alive to-day his tuberculosis would certainly have been cured. He would have been able to complete his unfinished novel, The Weir of Hermiston, perhaps the greatest of all his novels, and would have enriched the world's literature with many more great masterpieces.
So many patients say they welcome death, but next morning the sun comes shining in through the window; they feel that God is still in His Heaven; and there is once more the will to live. No doctor can shirk the duty of sitting at the patient's bedside as he faces death. At times the Angel of Death is hovering so close he can almost hear the beating of his wings. But every doctor, in his mission of mercy, will have to hearken to the patient's plea and then decide the issue for himself. Permissive legislation is not likely to lighten his burden. He must struggle with his own conscience, and will invariably prefer to continue under the existing sanctions.
This Bill is still before its time. It has not been allowed the opportunity to be stillborn. We have had the opportunity to-day of debating it at length. Perhaps in twenty years from now, when artificial insemination and test-tube babies are the accepted thing, this Bill will have earned its place on the Statute Book. But, meanwhile, I must very reluctantly vote against its Second Reading.
§ 8.19 p.m.
My Lords, I rise only to make a suggestion. It is a suggestion to the noble Lord, Lord Raglan, to this effect: that in his closing speech this evening he should say to your Lordships that if the House will give a Second Reading to this Bill he will give an undertaking to move that it be referred to a Select Committee. My Lords, about a year ago, when I was sitting in this House, I was astounded to hear that I was the last person to have moved such a resolution. That was in 1939, and apparently it has not been done since. But I believe that this is essentially the sort of Bill in respect of which it would be appropriate for that sort of resolution to be moved. The machinery of it would be simply that the noble Lord would say, "If the House gives the Bill a Second Reading, I undertake to move, perhaps in 1247 a week's time, that it go to a Select Committee." It would then go to a Select Committee who would hear all the experts from inside and outside the House at leisure and report on it in writing, perhaps with Amendments, perhaps not. Then it would be considered again and, finally, there would be nothing to prevent its going to a Committee of the Whole House in addition to being referred to the Select Committee. Both could be done. I venture in all humility to make this suggestion.
§ 8.20 p.m.
§ LORD FERRIER
My Lords, I am grateful to the noble Lord who has just sat down for making this suggestion, with which I am in complete agreement, though I should not have had his temerity to propose it; nor have I his experience. His action has given me a moment's breath before following the noble Lord, Lord Segal, whose moving, compassionate and practical speech impressed me greatly. I am moved to speak because I agree with the noble Lord, Lord Ailwyn, when he said he believed that public opinion has moved forward in this matter over the last few years. While I sat here I had thrust into my hands a letter from my sister in the North of Scotland. It contains a poem of hers, a verse of which I will read. It is called, "Thoughts on a Geriatric Case":If to abort birth is to thwart God's planis not aborting death as grave a treason?There is a time for going as well as for arrival.This is nor life, nor death;it has no rhyme or reason, but 'medicated survival'!I quote that, my Lords, because I feel very much with the writer.
I have two points to raise which have not been mentioned in the debate. One is that, except for the speech of the noble Lord, Lord Ritchie-Calder, I heard no disputation on the ethical and moral subject, which worries me and which is connected with the fact that not only surgery but also pharmacology has produced a measure of death control. I should have liked to hear perhaps from the Bishops' Benches a disputation on: Where do we stand? Is it right that we should vaccinate or use antibiotics? Is it right that we should contemplate euthanasia?
My Lords, my second point, other than supporting what the noble Lord, 1248 Lord Merthyr, said and suggesting that the noble Lord, Lord Raglan, carefully consider it, is that we have heard no mention of the life assurance industry. I am a director of an insurance company and it seems to me that a Select Committee such as has been suggested would be able to take into consideration the problems which are obviously connected as between life insurance and a Bill of this nature. Those are the two points which I have picked up from the debate. I would again reinforce my support of what Lord Merthyr has said.
§ 8.23 p.m.
VISCOUNT ST. DAVIDS
My Lords, I should very much like to ask my noble friend Lord Raglan to agree with the noble Lord, Lord Merthyr, in his suggestion. It seemed to me an excellent one. I came to this House slightly against this Bill and throughout the debate have become more against it. There are a great many arguments which I think the House ought to consider, and I think it would be a very good thing for this country if we could have a Select Committee go thoroughly into this matter so that any future mover of such a Bill would know just where right and wrong stands in this matter. I believe that a Select Committee would do valuable duty to this House and to this country. Therefore, if my noble friend will agree to the suggestion that has been put forward, I shall vote for the Second Reading. Otherwise, I shall vote against it.
THE LORD BISHOP OF DURHAM
My Lords, may I ask whether such a Select Committee would be restricted to concerning itself with the Bill or with the issues which the Bill embraces? I ask, for information, whether the Committee would have wide terms of reference or would be restricted to examining the Bill.
§ LORD BESWICK
My Lords, if the question is directed at the Table, the Select Committee can consider only the Bill.
§ 8.24 p.m.
§ LORD RAGLAN
My Lords, I have listened to nearly every speech with the greatest attention and I think this has been a very valuable debate. I was going to attempt to answer at any rate some of the points raised in the speeches of noble Lords, but as the debate went on 1249 I decided that I could not. In any case, your Lordships have been here for a long time and probably would rather that I did not do so. With respect, I think that several noble Lords have got hold of the wrong end of the stick and have beaten both me and the Bill with it. I was rather struck with the noble Lord, Lord Brock, who said that the Devil can quote the Scriptures for his own use; and who then went on to quote a great many of Scriptures. There was one remark that I rather resented. The noble Lord, Lord Newton, taunted me, I think, on the barbarous penalties (so he called them) for forging or falsifying the declaration; but I think I should point out that if lesser penalties had been inserted in the Bill I should have stood the risk of more than one noble Lord jumping on me and saying that such penalties were not enough. Of course, these are just the sort of matters which could be threshed out and decided in Committee.
There has been much criticism of the wording of the Bill. It has been suggested that there are many loopholes. My noble friend Lady Serota, speaking for the Department of Health, said that there were formidable practical difficulties in carrying out the provisions of the Bill. I have to accept what she says about those difficulties although I do not accept everything else that she said. However, I do not think that it would be in the least impossible to find either a form of words or a code of regulations which would satisfy your Lordships and the Ministry of Health.
My Lords, I have two courses. One is to withdraw the Bill and to come back, in time, with another. The other course is either to ask your Lordships to give the Bill a Second Reading in order that we may try to perfect it in Committee or to take the suggestion of the noble Lord, Lord Merthyr, and to ask your Lordships, having given it a Second Reading, to allow me to move that it be sent to a Select Committee which can call expert evidence and get the whole subject thoroughly probed and discussed upstairs. Or, as the noble Lord, Lord Merthyr, suggested, we could do both. I think that would be a most useful thing to do. I do not know whether on those latter terms the noble Earl, Lord Cork and Orrery, would be prepared to with- 1250 draw his Amendment or whether his objections are so rooted and fixed that he finds he cannot do so. I hope very much that he can. But if he cannot, I would say to those noble Lords who support the principles of the Bill and to those who think that we ought to send it to a Select Committee, even though they disagree with the present terms and are not very fond of the Bill, that their aims and those of the noble Lords who support the Bill in its present imperfect form are much the same. Many noble Lords think that some form of voluntary euthanasia is most desirable and others would like to find out more about it.
My Lords, nothing that has been said to-day against the Bill has persuaded me to think differently from when we started the debate. I appreciate the reservations of many noble Lords, but I think there must be some way of giving people this freedom and therefore, if it comes to a vote, I hope that those noble Lords who are in favour of the principle of the Bill will go into the Lobby against the Amendment.
§ 8.30 p.m.
§ THE EARL OF CORK AND ORRERY
My Lords, it is practically impossible now to make a winding-up speech of any length, in the sense of commenting on what noble Lords have said, and I shall make no attempt to do so. We have heard great argument, and my impression is that most if it has been in favour of the Amendment and against the Bill. But I take no stand on any statistical facts or calculations of that kind. My own feeling about the Bill has not been changed; indeed it has been fortified by the speeches of many noble Lords.
I am particularly inclined to pay attention, as I expected to find myself doing before the debate began, not so much to the speakers from among the Lords Spiritual or those on other Benches who speak from religious or moral grounds (these I sympathise with in many eases) as to the views of the doctors. That is my personal standpoint because, as noble Lords may remember, I said at the beginning that I was speaking not for or against the principle of euthanasia but against the Bill, and the people who would have to operate the provisions in the Bill are doctors. We have had five doctors of great distinction speaking in 1251 the debate, and only one spoke in favour of the Bill.
Perhaps the most moving speech of all from the doctors, and the most recent, was that of the noble Lord, Lord Segal, who managed to combine experience, knowledge, compassion and practical common sense all in one deeply moving, short speech, for which I think we may all be grateful, however we feel upon the subject. The noble Lord, Lord Amulree, whom we must regard as a particular authority in that he operates (by which I mean that he functions) in the world of the geriatrician, has declared himself against the Bill. He made, as I see it, a particularly important point: that in his experience the demand, or request, for euthanasia came not from patients but from their relations. And this, I think, underlines one of the dangers.
The noble Lord, Lord Brock, put a point in a particularly graphic way, I think, when he said that to sign a declaration in early life which would entitle one to euthanasia in later life was like joining a club. And here I am sure that he touched on a danger, as indeed I did myself; and it is one that has been referred to over and over again: the danger of a declaration which might have been in force for years and might take effect even after a patient had changed his mind. That is a very real danger, and I see no escape from it.
Then I think we should be on our guard against a particular type of argument, one that was not greatly represented in the debate, but it has been mentioned by one or two noble Lords—one in particular; and that is what, if I may use the word without any sense of disparagement, I might call the sentimental argument; that which describes what one sees in a ward full of old people. Probably we have all seen this. The noble Lord, Lord Ailwyn, described a scene and said one felt stifled by a feeling of the all-pervading lethargy and the pathetic sadness. My Lords, lethargy is not inappropriate in the old. It is not particulary inappropriate, I hope, even in those approaching old age. If it is stifling it is not stifling to the person who is lethargic; it is stifling to the spectator. As for the pathetic sadness, can one be sure that the pathetic sadness one experiences is not one's own, and not that of the patient? I 1252 think it a fallacy to suppose that all people who are old and at the point of death are immersed in sadness and despair.
My Lords, I take the point raised by the noble Lord, Lord Clifford of Chudleigh, that people who are a burden need the protection of society, not the benison of being put out of the way by society. I take also the plea made by many noble Lords, and perhaps first by the right reverend Prelate the Bishop of Durham (I cannot quote it exactly), for a new thinking towards the old; not leading to euthanasia to put them out of their troubles, but towards a new education, and for a great growth of institutions such as that represented by my noble friend Lord Thurlow in the hospice of which he spoke, which I think—though I am not sure—is called the Hospice of St. Christopher. There are alternative lines of thinking to the thinking that leads to euthanasia, and I beg noble Lords to devote their attention to them rather than to the idea of simply getting rid of people.
My Lords, I have taken my stand, and I continue to take it, on the fact that this is a bad Bill. It is full of dangers, as has been pointed out by one and all, from beginning to end of the debate. There have been very few speakers who have denied this and none, I submit to your Lordships, who has disposed of any single argument of that kind. There remains the suggestion made by the noble Lord, Lord Merthyr, that the Bill should be withdrawn (though as a matter of fact, the Bill cannot be withdrawn, because there is no Motion before your Lordships' House in favour of the Bill), or that the Amendment should be withdrawn, and the Bill referred to a Select Committee.
My Lords, I did not make any suggestion about the Bill being withdrawn. I suggested merely that the noble Lord, Lord Raglan, should undertake that if your Lordships gave it a Second Reading he would move—that is, after the Second Reading and before the Committee stage—that it be referred to a Select Committee. I did not mention withdrawal.
§ THE EARL OF CORK AND ORRERY
I apologise, my Lords, and withdraw unreservedly. I perfectly understand the 1253 situation and the proposal. But if a Select Committee were to be set up, it would, as I understand it, be a Committee to consider this Bill. My Lords, I am afraid that the noble Lord, Lord Raglan, is right in supposing (though I do not know whether he put it in precisely these words) that my objection to the Bill is too rooted and too fixed to agree to this proposal. I am not being bigoted about this, but I do not see why, if a Select Committee were set up, it should have to discuss merely this Bill. The issue before your Lordships' House, and before Parliament and the country,
§ Resolved in the affirmative and Amendment agreed to accordingly.1254
§ is the issue of euthanasia. By all means let us set up a Select Committee, or any other inquiry to investigate that. But in the meantime let us forget this Bill, which I believe to be ill-drafted beyond repair; and, as I said in the first place, let us commit it quickly and quietly to a painless knock on the head.
§ 8.40 p.m.
§ On Question: Whether the said Amendment shall be agreed to?
§ Their Lordships divided: Contents, 61; Not-Contents, 40.1253
|Amulree, L. [Teller.]||Gainsborough, E.||Perth, E.|
|Auckland, L.||Gray, L.||Phillips, Bs.|
|Barrington, V.||Greenway, L.||Piercy, L.|
|Beswick, L.||Grenfell, L.||Poltimore, L.|
|Brock, L.||Hall, V.||Rankeillour, L.|
|Carnock, L.||Headfort, M.||Redesdale, L.|
|Chalfont, L.||Hilton of Upton, L.||St. Helens, L.|
|Champion, L.||Howard of Glossop, L.||St. Just, L.|
|Chester, L. Bp.||Hylton-Foster, Bs.||Segal, L.|
|Clifford of Chudleigh, L.||Iddesleigh, E.||Stow Hill, L.|
|Colville of Culross, V.||Inglewood, L.||Strabolgi, L.|
|Cork and Orrery, E. [Teller.]||Kinloss, Ly.||Summerskill, Bs.|
|Craigmyle, L.||Lauderdale, E.||Taylor of Mansfield, L.|
|Cromartie, E.||Longford, E.||Terrington, L.|
|Denham, L.||Loudoun, C.||Teviot, L.|
|Dundee, E.||Lytton, E.||Thurlow, L.|
|Durham, L. Bp.||Milner of Leeds, L.||Vivian, L.|
|Exeter, L. Bp.||Monckton of Brenchley, V.||Waverley, V.|
|Falmouth, V.||Mowbray and Stourton, L.||Wells-Pestell, L.|
|Ferrers, E.||Newton, L.||Wise, L.|
|Addison, V.||Grimston of Westbury, L.||Popplewell, L.|
|Ailwyn, L.||Henley, L.||Raglan, L. [Teller.]|
|Archibald, L.||Huntingdon, E.||Ritchie-Calder, L.|
|Balerno, L.||Jackson of Burnley, L.||St. Davids, V.|
|Beaumont of Whitley, L.||Kilbracken, L.||Shackleton, L. (L. Privy Seal.)|
|Bowles, L.||Lambert, V.||Stonham, L.|
|Brockway, L.||Listowel, E. [Teller.]||Strathcarron, L.|
|Brown, L.||Llewelyn-Davies of Hastoe, Bs.||Strathclyde, L.|
|Delacourt-Smith, L.||Merthyr, L.||Swansea, L.|
|Evans of Hungershall, L.||Nunburnholme, L.||Taylor of Gryfe, L.|
|Ferrier, L.||O'Hagan, L.||Tweedsmuir, L.|
|Foot, L.||Platt, L.||Wade, L.|
|Goodman, L.||Plummer, Bs.||Wellington, D.|