Lord Birt
Main Page: Lord Birt (Crossbench - Life peer)
Lord Birt (CB)
My Lords, I shall speak also to all the other amendments listed in my name and that of the noble Lord, Lord Pannick, who, having assiduously attended our sessions on the Bill thus far, as all will have noticed, deeply regrets that he cannot be present with us today.
Our discussions to date have focused overwhelmingly on risk, and I do not for one moment dispute the necessity and the value of that. I will return to how best we can manage those risks later in my remarks. However, let us not forget that we are not pioneers. Thirty countries, states or jurisdictions across the world have already introduced assisted dying. The first did so over 80 years ago; there has been a steady stream this century and, hot off the press, just two days ago, an assisted dying Bill for the Channel Island of Jersey passed its First Reading by a two to one majority and is expected to pass into law next month. It is therefore at the very least equally important that we do not just focus on risk but lean on the well-established experience of others when considering the critically sensitive matter before us, which we know from serious studies carries overwhelming public support.
For my part, I have been exposing myself to the Australian experience, with considerable help from senior practitioners, for which I am most grateful. Without exception, those to whom I have been exposed come over as deeply caring and enormously considered. What I have learned from them, and from the copious data that is available, is reflected in the amendments before your Lordships today. Much that I have discovered has been surprising as well as enlightening. First, applications for assistance in Australia are not automatically accepted; something like one-third are turned down. Secondly, around 75% of those seeking assisted dying have cancer, and somewhere between 75% and 90% of all those who come forward are already in receipt of palliative care and are more motivated by their distress and misery than by their pain. Although I completely agree with all noble Lords who have stressed how vital it is to have effective, universally available palliative care, it is clear that it is not sufficient for many experiencing truly horrific medical conditions.
For those who have not read it, I commend Jonathan Dimbleby’s moving account in a recent New Statesman of his brother Nicholas’s harrowing final days. Nicholas had fallen victim to motor neurone disease. It became impossible for him to take solid food without choking. He then had a tube inserted into his stomach, through which he had to feed himself. Nicholas became increasingly hard to understand. He was barely able to move. He lost control of his bodily functions. He was often frightened and sometimes terrified. He gasped in vain for breath. Nicholas Dimbleby, finally and mercifully, died in February of 2024. Other UK practitioners I have met recently, simply by chance, have shared with me equally horrific accounts of deaths that they have witnessed in the ordinary course of their work.
Such experiences must explain why, in Australia, although around 10% to 15% of those seeking an assisted death apply some months in advance of their anticipated need, a significant proportion wait until their suffering is unbearable. As a result, around 25% of applicants die within nine days of their first request—I repeat, 25% of applicants die within nine days of their first request. A further 25% die within 10 to 19 days. Thus, in Australia, around 50% of applicants die within 19 days of their first request. The leading Australian practitioners who have advised me insist that sheer misery is the primary determining motivation of individuals seeking assisted dying. Further to illuminate the complexities of the process, around one-third of those who ask for and are given the death potion do not take it and choose to die a natural death.
Lord Birt (CB)
No, I am sorry—I have an argument to put; I am not going to take any interruptions.
Furthermore, one of Australia’s most senior and experienced practitioners tells me that, although in theory it must be a risk, she herself has never experienced a single example of coercion. On the contrary, she says, she has on occasions experienced the very opposite: loved ones understandably pressing someone who wants assisted dying not to embark on that course of action. Overwhelmingly, her experience is of applicants who know their own minds and are perfectly able to make a considered decision.
From all my discussions, I have concluded firmly that if this Bill passes into law, it is vital that the processes are based on day-to-day realities, as well as risk, and work efficiently and sensitively for any individual of firm and settled mind coming forward in a state of deep distress. We need more flexibility in the timelines of the process than the present Bill allows and a fit-for-purpose organisational focus that delivers promptly and humanely for individuals in severe need.
In our amendments, the noble Lord, Lord Pannick, and I propose three key measures. The first is to create a new organisation, the assisted dying help service, to enable the individual easily to navigate the complex process set out in this Bill, which in essence we retain. The second is to ensure that the assisted dying process is expeditious and, when conditions demand it, flexible. The third is that the commissioner acts solely as a regulator, with oversight but without any delivery responsibility.
The process currently set out in the Bill involves a 10-stage process, with three separate medical consultations with three different doctors, a confirmatory panel and two periods of reflection, the first of seven days and the second of 14 days, the latter of which can be shortened. Absent a bespoke organisational focus, this process in a stressed NHS could take a wholly inappropriate and disproportionate period of time. Hence our proposal is that we adopt a notion present in many jurisdictions of a purpose-built organisation—an assisted dying help service—that would provide a personal navigator to take the dying person and their loved ones through the whole complex process, providing introductions, keeping to timelines and piloting the individual through their final challenging and traumatic journey. Our amendments also propose appropriate flexibility, at every stage, with safeguards for doctors to act with urgency if the individual’s condition demands it.
Lord Falconer of Thoroton (Lab)
I will certainly try to provide that co-operation.
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 Fox of Buckley (Non-Afl)
To clarify, I am sure the noble Lord knows people who have tried to get a hip replacement or a wide range of other medical treatments. It is the most complex process that you could ever go through. Many people are vulnerable and could do with a navigator. Does he understand the two-tier nature of appointing a navigator in one instance and not in another? This follows on from the earlier question from the noble Lord, Lord Moylan. Can the noble Lord see that anything that seems to give preferential treatment to those seeking assisted dying over those who are suffering pain from a bad hip or who have a rare cancer and are terminally ill would cause political problems? Immorality might be part of the issue there.
Lord Birt (CB)
Believe it or not, I have had cause, at various times in my life, to navigate the NHS, as probably everybody in this Committee has, and of course it is very difficult. However, when you go into A&E, you effectively do have a navigator. I do not think this is about the hip operation example; it is about people in a genuine emergency situation.
Baroness O'Loan (CB)
I have been to A&E many times, particularly with my son, and I have never had a navigator. How does one have a navigator in A&E?
Lord Birt (CB)
I am sorry; perhaps the noble Baroness can talk to me later, as I could not take in what she said.
I am, frankly, open-minded about the NHS question and accept the strength of what the noble Lord, Lord Stevens, says. It may well be that this is an organisation that should be apart from the NHS but uses some of its services. However, I am happy to talk to others about how best to do that.
I reassure the noble Lord, Lord Harper, that the process can, and should, be designed not only to support assisted dying but to painstakingly explore the alternatives to assisted dying, and I did say this. We suggest that palliative care should be one of those services and, whatever the reasons that people have for assisted dying—there may be others beside their chronic near-death state of mind—we also propose that the organisational body should be able to help the person in other sorts of ways. We want it to be a balanced process.
Lord Harper (Con)
I am grateful to the noble Lord for taking my question at this stage of the debate. I listened very carefully to him when he was setting out his proposals and I welcome the fact that he said that the navigator can discuss palliative care and such issues with the person concerned. Unless I misunderstand his amendments, they do not propose to help secure those services for the person. They might set out what they are, but they do not get them, so there is an imbalance there. They will help them get the assisted suicide but not proper palliative care.
Lord Birt (CB)
I do not think it for us, in framing in principle amendments, to deal with that level of issue, but the noble Lord is right—that is exactly what the body should do. We are talking about highly distressed people, and it should facilitate different kinds of response and reaction to their difficulty.
Lord Blencathra (Con)
If I heard the noble Lord correctly, he said that anyone going to A&E gets a navigator. He was challenged by the noble Baroness, Lady O’Loan, but he did not hear her question. She said that she never experienced that in her life and neither have I. If any noble Lord has, I would be grateful to hear it. If you go to St Thomas’, the first people you meet are two security guards who are there to keep people out.
Lord Birt (CB)
Plainly, the NHS is a very large organisation and it offers a variety of different kinds of experience. I hope none of us uses A&E very often but, like everybody else, I have used it and, in my experience, I have found it very efficient indeed at handling everything.
As I have said already, there are many issues and if anybody wants to talk to me and the noble Lord, Lord Pannick, about them, please do. I end with a very simple point, and I address this particularly to the noble and learned Lord, Lord Falconer. I am utterly convinced that this needs a proper organisational framework. You cannot throw this complexity of issues at the National Health Service. It also needs a more flexible process than currently exists to deal with the complexity that I have outlined, which comes out of the Australian experience. Both those things need to be in the Bill, and the noble Lord, Lord Pannick, and I will be returning to these issues on Report with, I hope, as much help from across the Chamber as possible. In the meantime, I beg leave to withdraw the amendment.