Baroness Grey-Thompson
Main Page: Baroness Grey-Thompson (Crossbench - Life peer)
Lord McCrea of Magherafelt and Cookstown (DUP)
I thank the noble Baroness for that.
This has been a telling debate thus far, because we are told that some of the points are based on opinion polls. We are not an elected Chamber and therefore we do not have to be swayed by how we are to get elected next time. Therefore, it is so important that we do not make laws on opinion polls. In fact, we have to debate the issues carefully—and trust that we are therefore making mature decisions—and seek to get the Bill right, because the issue that we are debating concerns life and death.
I have found something somewhat surprising whenever the cost has been talked about. Many people are rightly demanding an answer concerning the cost. The noble Lord, Lord Markham, mentioned it a number of times. I was in this House when he was a Minister, but he is not now answering for the Government; I believe it is important that the answer comes from the Government Minister, who should give us the up-to-date cost. For any of these issues, costs do not minimise over the years. In fact, they increase—we will find at the end of the day that the costs will escalate. We heard in the debate yesterday that the cost of the Chagos Islands will be £3.4 billion, yet it was suggested on the Opposition Benches that it will be £34 billion. I am sure Members realise that there is quite a difference between those two figures—there is a dot between £3.4 billion and £34 billion. Nevertheless, we are talking about massive sums of money. We are also talking about money that could be taken from another part of the health service, which in many parts of the country, and certainly in Northern Ireland, is crying out for money; it needs every pound it can possibly get.
I believe the Bill was defective as it came from the other House, but I also believe that what has been proposed by the noble Lord, Lord Birt, would make the Bill worse. The proposal here undermines choice even more. There is no equity of access under these amendments. What genuine choice is there if you can get an assisted death within 30 days but you have to wait months for the palliative care that you need? Palliative care is not available in many parts of the country; it is certainly not equally available right across the country.
Do the supporters of these amendments accept similar amendments that require palliative care treatment options to be made available and accessible within the same timeframe as this? They might say, “Yes, we would accept that”, but it is not a reality. There is no reality in which you will get palliative care within 30 days, because it is not available in many parts of the United Kingdom. How is it fair that terminally ill people get a personal navigator to support them through the process of getting an assisted death, but they do not get a personal navigator for gaining access to the palliative care they desperately need?
There are issues that need careful reflection. In the light of what the noble Lord, Lord Empey, said, I note the following. In our debates over the past few weeks, the noble and learned Lord, Lord Falconer, has said that he would reflect on some of the issues raised, but up to now I have not heard what that reflection has brought about in changes that need to be made to the Bill. Perhaps it would speed up the debate if we could get some knowledge about the reflections that he has had and some of the changes, in the light of the debates that have already taken place, that he will actually make in order to make the Bill more acceptable to many noble Lords.
The issue that we need to continue to reflect on is the extraordinary speed suggested by the noble Lords, Lord Birt and Lord Pannick. It undermines safeguards. Mandatory timelines force decisions without proper investigation. Panels must decide within two days of referral, even over weekends. I know of no other decisions made in the health service for which you can be promised that. There is also no judicial precedent for such haste, because courts take months for life and death decisions—yet this process is so fast.
Then we come to prognosis inaccuracy, which seems to be ignored. As I said to the noble Lord, Lord Pannick, in a previous debate, I have known people who were given a six-month prognosis but continued to live three years later. Therefore, there is no consideration of prognosis inaccuracy. Rushing assisted death risks premature deaths.
Then we come to mental health risks. Reflection periods would be cut to 24 hours. Experts warn that depression after diagnosis is often temporary and treatable. Why can patients get an assisted death in 30 days but have to wait months for palliative care? Also, the amendments erode protections rooted in law and ethics; suicide prevention remains government policy.
In conclusion, I ask the Minister these questions. How can panels make life and death decisions within 48 hours without sacrificing due process? What safeguards exist against coercion when timelines are compressed, as suggested by the noble Lords in their amendments? How will the National Health Service meet these demands when GPs and social workers are already overstretched? We had and have, in past debates and up to this moment, numerous questions, but, from the noble and learned Lord, Lord Falconer, the Front Bench and the Government, we have very few, if any, real answers that we can hold on to.
Baroness Grey-Thompson (CB)
My Lords, I read this group of amendments with a lot of interest, in terms of whether a different way would be possible. I thank my noble friend for tabling them.
I agree with the right reverend Prelate the Bishop of Newcastle that Australia is not an accurate comparative country to look at. Actually, it makes me feel even more strongly, and the Minister will have received a letter this week from many of us asking for the impact assessment to be looked at again. One of the reasons for that is that the impact assessment looks at about the first 10 years in Oregon. If we compare data between Oregon and the state of Victoria, it took Oregon 17 years to reach the same number of deaths that was hit in the state of Victoria—not Australia, but the state of Victoria—in the first 12 months of its Bill passing.
I accept that the first voluntary aided death in Victoria was described as beautiful, but in the time that that legislation has been enacted, it has thrown up many issues. In 2023-24, there were a number of complications with intravenous injections. There were technical problems in 5% of cases. In 10% of cases, the death took longer than expected—one person took seven days. In 29 responses, the death more than two hours. In seven reported cases, it took more than six hours, and the longest was 11 hours. So, we have to be really careful about painting other jurisdictions as the sunny uplands.
There was a case reported in the Times on 22 March last year, where a man had requested the drugs to end his life. He had decided that he wanted to have longer left to live, and his wife gave him the drugs anyway, because, I presume, she decided that it was his time to go. It is a very different jurisdiction, but it again raises issues of coercion.
We also have to note with Victoria that, since its legislation has passed, elder suicide has risen by 50%. These are the things that we must take into to account when we are looking at what happens in this country.
I thank the noble and learned Lord, Lord Falconer, for arranging a meeting last year, when we were able to meet some Australian medics, but that gave me even more cause for concern, because there was a story of man who had taken a while to come to a decision to have an assisted death. The day he finally decided to have it and started taking the noxious mixture, he did not want to carry on and his family said, “But, Dad, you’ve decided to die today, you need to keep taking the mixture”. All these things worry me when we look at the speed with which these navigators might be able to push someone towards assisted suicide. In principle, a navigator sounds great, but they are only pushing people one way. We do not know enough about the training or whether, potentially, an AI bot might be used at some points. As has been raised, this could potentially just be debated in a 90-minute debate on a statutory instrument. So we have to look much more carefully at these areas. I do not think these amendments are adequate for what we want to do.
My noble friend Lord Birt raised the extremely sad case of Nick Dimbleby. But, as far as I understand, with his condition, MND, he would be not eligible for assisted suicide under the Bill. I would welcome the noble and learned Lord, Lord Falconer, confirming that.
It has been raised in different ways and on different days that our experiences of pain are very different. In other debates, we have talked about incontinence: what one person thinks is awful, another might think “I can live with it, it’s okay”. My noble friend Lord Birt talked about someone being PEG fed. Unfortunately, there is an inequality of the system in this very Chamber. My noble friend Lady Campbell is not able to respond to this group of amendments because she can only speak at the start. She cannot intervene later, so she is not able to listen to the debate and pick up points. I am sure she will be able to raise it, and I beg your Lordships’ tolerance because she might have to raise this in another group. There has been talk about being PEG fed being awful, but being PEG fed has enabled her to survive and to contribute. I worry about the inequality of this Chamber in terms of people being able to contribute properly.
Amendment 223 looks at this happening in four days. I do not believe that there is any system that will be able to, in that period of time, assess whether somebody has been coerced. Amendment 336, which says that the second assessment could happen after a period of reflection of seven days, does not even vaguely take into account the five stages of grief. There are not that many papers on people with spinal cord injuries, but one that I have read says that it can take up to seven years for a wheelchair user to get over the experience of traumatic injury. If you take that into account, people will be forced very quickly to end their life, when the ability to deal with the issue that is in front of them has not been taken into account.
Lord Birt (CB)
My Lords, I will try not to keep us too long from our lunch. This has been a lively and helpful debate, and I think it has exposed a fair number of critical issues that are yet to be resolved.
My past has caught up with me in this debate. How many people here knew that I used to be the boss of the noble Lord, Lord Gove? It was not my fault. He was a genuinely distinguished young BBC journalist, in all seriousness, and hugely admired by his colleagues. The debate has also revealed that the noble Baroness, Lady Coffey, and I went to the same north Liverpool grammar school, so anybody who objects to anything that she or I put forward can blame the Irish Christian Brothers.
I cannot possibly deal in any detail—and noble Lords would not want me to—with the many points raised over the past three hours. I approached the construction of these amendments, with the noble Lord, Lord Pannick, with a truly open mind, and I retain an open mind. The Chief Whip often tells us that his door is always open. My door is always open—not that there is one, because I do not have a proper office—and I am completely open to discussing any issue that has been raised. I am sure that the noble Lord, Lord Pannick, and I will wish to return to these matters when we come to Report.
I will just say a few things now. I approached the Australian practitioners with a completely open mind. I was in favour of assisted dying but I wanted to understand what real-life experience was like. I am very data-driven, as the noble Lord, Lord Markham, has often pointed out, and wanted to immerse myself in the Australian data. It was my learning, and then discussions with the noble Lord, Lord Pannick, that caused us to frame our amendments in the way we did.
The central thing that emerged from those discussions, which has been lost in our debate so far, is that, actually, people are not coming forward. They already have palliative care. Their pain is more or less controlled. The central point that the Australian practitioners wanted to get across to me, over and again, was that this is about misery, and people running out of time and wanting to end their life. Hence the key Australian data I shared was that, roughly speaking, 25% of people who come forward for assisted death die within nine days.
That is why I told the Committee about the Nicholas Dimbleby experience, because I thought that was indicative of the kind of people who want it. It is at the end of a very painful, prolonged process of suffering that people want an expeditious end. That is why the noble Lord, Lord Pannick, and I have sought to retain the process that is in the Bill but tried to make it more flexible, to deal with what can be genuine emergencies. And it is an emergency. There is a part of the National Health Service that deals with emergencies on Christmas Day—it is called A&E. We are talking about a service that will deal with genuine emergencies.
Baroness Grey-Thompson (CB)
My apologies for intervening, but my noble friend mentioned the number of people who access palliative care. The state of New South Wales promised £743 million in extra funding for palliative care over a five-year period, but, when the law was passed, it cut that funding by £150 million and diverted money to assisted suicide. Does my noble friend accept that, although he says people are getting palliative care, big promises are being made and then ripped away from people? It limits the choice they have, because there is not as much palliative care support as they originally thought. There is a feeling that that was promised just to get the Bill across the line.
Lord Birt (CB)
The one issue that unites the whole Committee is that we have to have an effective service of palliative care in this country. The data in Australia, which varies from state to state, tells us that somewhere between 70% and 90% of people who come forward already have palliative care.
The noble Baroness, Lady Fox, talked about navigation. It is a complex process, even in the Bill as it stands. If you analyse the likelihood, you will find that it will probably take, without the right process involved, 30 to 60 days, which is completely inappropriate in the context of the Australia experience. By the way, the navigator is an administrative role to help the person manage a complex system with multiple practitioners, who themselves have real authority.
Baroness Finlay of Llandaff (CB)
I have looked after thousands and thousands of patients, and I have to say that I have never come across someone who said they wanted to be terminally ill and to have their metastases or whatever. No, people want to live well but accept that death is a natural part of life. That is quite different from talking about deciding that someone is going to be given lethal drugs to foreshorten their life.
The benefit of the amendments proposed by the noble Baroness, Lady Berger, is that they fit fair and square with the Title of the Bill, which is about terminally ill adults, and make it clear that this is about terminal illness and cannot be masqueraded as anything else. Yes, there will be multiple factors, because of course someone who is already seriously ill but is content with their life will not seek assisted suicide—that goes without saying. However, we also need to be clear about differentiating medication, which is where we give a substance with the intention of achieving an improvement to the person’s well-being, from the large cocktail of lethal drugs that we debated previously, and I am not going to revisit that.
I have a concern when we label all these patients as having pain and suffering. Evidence from other countries is that pain and suffering are not the prime reason why people are going for this. I see the noble Baroness, Lady Jay, nodding, and I remember well from the Select Committee that we were on that we heard repeatedly that there were multiple existential factors that made someone’s life have so little meaning and worth that they felt they wanted to go for assisted suicide. However, we have to put some boundaries around it, because literally thousands of people in this country feel exactly that—that their lives are of no worth—and they feel suicidal. As Professor Louis Appleby, the lead suicide prevention adviser to the Government, has said,
“I’m worried once you say some suicides are acceptable, some self-inflicted deaths are understandable and we actually provide the means to facilitate the self-inflicted death. That seems to me to be so far removed from what we currently do and from the principle that’s always guided us on despairing individuals, that it’s an enormous change with far-reaching implications”.
The amendments would provide a ring fence and some safety barriers. Sadly, there are literally thousands of people in society who are suicidal. We heard a lot about that in relation to young people and the algorithms on their phones that they get into with social media and so on. There are an awful lot of people who are profoundly depressed and a lot of people in poverty, and when they become ill that may take them down one further notch, and there are a lot of people who just feel unloved. We have to make sure that the Bill sticks to what it claims to do, which is to be about terminal illness.
Baroness Grey-Thompson (CB)
My Lords, in other groups last week, I covered issues of why I was concerned about people requesting assisted suicide because they feel like a burden, so I will not seek to rehearse those, but we should care about the other reasons why people’s decisions might be impacted, not least because in 2022 Marie Curie said that when someone is given a terminal diagnosis they are quite often financially impacted by that. So not only do you have the trauma of the diagnosis but other things happen and fall apart very quickly around you.
I know that Members of the Committee from all sides have worked on welfare reform and on the Legal Aid, Sentencing and Punishment of Offenders Act—all designed to provide better support for people who may need it. It is great to hear that there are GPs who will offer support on benefit claims and to put other things in place, but I cannot quite understand and work out where in the process people would be signposted back to the GP. We know that there is often a long waiting list for people to get a GP’s appointment; would one or both of the two doctors actually help somebody with a benefits claim or who would they signpost to? That is an important part of understanding the process.