Baroness Cass
Main Page: Baroness Cass (Crossbench - Life peer)
Lord McCrea of Magherafelt and Cookstown (DUP)
And I am responding by saying that if we want to be sure that there is no ambiguity whatever—we are talking about the issue of life and death and, by what was suggested earlier on, inside a matter of days this was all to be over—there should be clarity. I would have hoped that the noble Lord would want that too.
Baroness Cass (CB)
The GMC guidance would need to be amended because, at present, there is specific advice on guidance around supporting patients at end of life. It says:
“Where patients raise the issue of assisting them to end their own life, or ask for information that might encourage or assist them in doing so, respect for a patient’s autonomy cannot justify illegal action … Medical professionals should … be prepared to listen and to discuss the reasons for the patient's request”,
but
“limit any advice or information in response, to … an explanation that it is a criminal offence for anyone to encourage or assist a person to commit or attempt suicide”.
The current GMC guidance precludes all this and would therefore have to be changed should this Bill go through.
Lord McCrea of Magherafelt and Cookstown (DUP)
That is very helpful, and I trust the noble Lord, who is now nodding, will take that into consideration.
Lord Deben (Con)
I agree with everything that the noble Baroness said. That is not what I was saying. I was saying that many people, in seeking to get the Bill through, are not facing up to the fact that there are many people in society who will see this as an opportunity to find the better thing for them if their old grandmother decides to take her own life.
Some of us have spent many years working—albeit not as effectively as the noble Lord, Lord Mawson—among people who, frankly, are wonderful and have dealt with huge difficulties in their lives. But we have also found people who would be happy for the death of their grandmother for a matter of a very few pounds—and if their grandmother has a house worth £200,000, the situation becomes much clearer. They know what they want and they know what the pressure would be. In asking whether people have seen that, I must say to the noble Baroness that I have seen that—more times than I would really like to go through with her. Those of us who have worked all our lives in those circumstances—I think the noble Lord, Lord Mawson, will support me—will recognise that that is the case.
All I am saying about this amendment is that it helps to protect people against that, and it does so by saying that we, as a society, should be concerned that, if somebody thinks they ought to end their own life, even if they have only six months to live, because their housing is so bad, because they feel a burden to their family, or because they think the National Health Service should not be spending the money on them, we ought to do what is necessary to remove that reason. If, because of intolerable pain, they still wish to end their life, the Bill will be a proper means of doing it.
I will end with a simple point. The noble and learned Lord has explained why he does not want a reference to intolerable pain in the Bill itself. I understand that. That is why the noble Baroness, Lady Berger, has produced this answer, which is crucial not just because of the sort of society in which we live but because, if you do a public opinion poll, you see that people think that this Bill is about allowing people in intolerable pain to end their life. But it is not about that. What the noble Baroness is trying to do is to make sure that it is about that and that we do not become a society for which this becomes the cheaper way or the way in which people can use their influence to gain their own ends. The best way to add to that support is to support what she said. It is also a way for us, as a House, to say to the world that we are not concerned with this assisted suicide for any reason other than as an autonomous choice about real, terrible suffering.
Baroness Cass (CB)
My Lords, we know that people may have many of the problems that proponents of the Bill have described as reasonable justifications for why someone may want to end their life. They may already be a burden, as they see it, or incontinent, or under financial duress, or have pain from arthritis, or have a whole host of other things going on in their life. They may have fallen out with members of their family. There is a multitude of things. We have heard endlessly about that. Then, randomly, they get this ticket—the ticket that nobody wants—that says that they have only six months to live. Prognostic predictions such as that are based on averages, and the shocking fact, as we know, is that 50% of people are above average, so there will be a huge range. If you have been given a six-month prognosis, it could be anything from one month to 32 years, as we have heard.
To say that that is your ticket to be allowed to have an assisted death, and then completely disconnect that fact from the reasons for your assisted death, makes no sense at all. There is no internal logic in that. The amendment from the noble Baroness, Lady Berger, is brilliant in getting us past the intolerable suffering to something that is plausible, tangible and clear. As I have said previously, doctors make judgments all the time. The judgment about the six-month rule is hugely inaccurate, as I have just described, but the one thing that the doctor can usefully do is determine whether there is plausibility that the symptoms that are distressing the patient are related to that illness. They do not have to be the only reason; there can be all those other factors going on. But if there is plausibility that there are symptoms related to that illness—be it pain, breathlessness, incontinence or whatever else happens to be distressing to that individual—that seems to me to be acceptable. However, personally, I would prefer it to be limited to pain, breathlessness and things that may not be amenable to treatment.
None the less, that still gives the doctor some yardstick to determine that this is not just about coercion, even some internally driven coercion that the patient feels that it is their job to end their life. Anything else, and you are asking for somebody to make a judgment that is just not feasible. I cannot see—I have said this before —how it is feasible to assess whether the patient is feeling coerced in the way that the noble Baroness, Lady Fox, described in earlier discussions just because of the tutting and the head shaking at having to bring something to the patient or the person once again. This would give us something that is concrete, clear and defensible, which I think is what the public believe this Bill to be about.
Lord Falconer of Thoroton (Lab)
That was the very thought going through my mind as I listened to the noble Lord, Lord Harper, and the noble Baroness, Lady Fox. They just made the same speeches again. On the point that he is making, the question of why is worth asking for two reasons: first, it might go to the question of coercion; and, secondly, it might throw up something that can be remedied, but, in the example I gave about loneliness, it may well be that meeting an organisation in those circumstances is simply not enough and does not change the person’s view. That is why I say that autonomy, rather than parsing the reasons, is the right course. In those circumstances, I invite the noble Baroness to withdraw her amendment.
Baroness Cass (CB)
May I just correct something? The noble and learned Lord said that I wanted it to be only things that doctors can measure. It is not so much about things that doctors can measure. I was saying that it is about whether it is plausible—a doctor should have good judgment of this—that the distress the person is experiencing is in any way related to the illness with which they have been diagnosed. There is a subtle but significant difference because that is what helps you distinguish between it being that or coercion.
Lord Falconer of Thoroton (Lab)
I will think about what the noble Baroness said. Perhaps it is my fault for not getting it. I will not write, but I will talk to her and listen to what she says.