Lord Goodman of Wycombe
Main Page: Lord Goodman of Wycombe (Conservative - Life peer)
Baroness Fox of Buckley (Non-Afl)
My Lords, I ask the noble Lord, Lord Birt, to reflect on the equality implications of this suggestion of a special treatment service for those seeking assisted death. Following on from the previous contribution from the noble Baroness, Lady Royall, it seems to me that everybody would want, if they are a patient or for their loved ones, a personal, state-funded navigator. But maybe for care, those people on trolleys, waiting for operations, or trying to find their way into the care system would all say, “Can we all have one?” If we do not afford every patient in the country a personal navigator, is that not an unequal access to services? It seems a two-tier system, and one that I think the public would not approve of.
On another issue, I ask the noble Lord, Lord Birt, to detail the workforce demands that this service would require from the NHS, following on from the excellent contribution from the noble Lord, Lord Stevens. I note that the assisted dying help service—which, by the way, would be awarded significant regulatory powers by these amendments that would not be subject to approval by Parliament—would have the power to set training and qualifications for practitioners. That seems like a blank cheque. I would like to know what the skill set of a navigator would be and who decides that. In all seriousness, this whole new shadow service being set up, with its own qualification system and recruitment, is a bit worrying. We are not sure who they are going to be.
My final query is that I know that a lot of the Bill’s supporters are frustrated and have raised problems with some of the amendments that have been tabled on the basis that they would somehow create bureaucratic, preventive barriers to people who genuinely want to afford themselves an assisted dying service. In other words, there is an attempt to overengineer the process. Therefore, I commend the noble Lord, Lord Birt, on this creative attempt at cutting red tape. However, on these amendments, we all know that mandated timelines can mean shortcuts that could make the process unsafe. Could he comment on that?
Speed and process-driven decision-making are risky in any instance but, where careful assistance and safeguarding are contested, it seems rather dangerous that panels would have to decide within two days of referral, even sitting over the weekend or bank holidays to make decisions. By the way, I think we should apply that to everyone in the NHS: they should do operations and doctors’ surgeries should be open over weekends and bank holidays. I wish the courts would sit over bank holidays and weekends, because then we would not have to get rid of jury trials, allegedly. That would mean that a referral on a Friday evening would have to be decided by a Monday. How would a panel have time to investigate and read everything thoroughly? Surely it would just end up skimming things.
I also really worry about the reflection period being cut to 24 hours, when experts warn that initial depression after diagnosis, which is completely understandable, might well be temporary, treatable and certainly remedial. It could last a few weeks but then be replaced with a more positive attitude. In fact, the CEO of Mind told the Lords Select Committee that they have
“gone to the brink, have come back and have then been able to say three or six months later, ‘I’m so glad that that did not happen’”.
All I am saying is that saying, “Oh we’re being really efficient; we’re going to make sure that your reflection is cut to 24 hours so that you can get what you want”, might well mean that you do not get what you would have wanted if you had had a bit longer to reflect.
Lord Goodman of Wycombe (Con)
My Lords, there is an unreality about this debate that gives rise to a question for the sponsor of the Bill and the Minister. The unreality is this: the noble Lord, Lord Birt, has made the case for his amendments, and my noble friend Lord Harper and others have made the case against them, but there is hung on this whole debate an assumption that the NHS will deliver assisted dying. I remind the Committee that there is no guarantee of that in the Bill.
If noble Lords would kindly turn to Clause 41(4), they will see that the only reference to the National Health Service is:
“Regulations under this section may for example provide that specified references in the National Health Service Act 2006 to the health service continued”,
et cetera. That is the only reference to the NHS in the Bill. We do not know whether the NHS will or will not deliver assisted dying services. It is an extraordinary weakness in the Bill.
Baroness Berger (Lab)
The noble Lord and I sat on the Select Committee on the Bill. He may recall that I pressed the Minister specifically on this point: to clarify who would be delivering an assisted dying service in this country should the Bill be accepted. Only after a number of questions did the Minister acknowledge that it was the Government’s intention that the NHS would commission an assisted dying service. He could not clarify or confirm whether it would be delivered by the NHS, the private sector, the voluntary sector or charitable organisations and, if it was the private sector, whether it would be allowed to generate any profit. We are still unclear. It is very challenging to us, and I hope the Minister in her response might be able to give us further clarity on that important point.
Lord Goodman of Wycombe (Con)
The noble Baroness, Lady Berger, is quite correct. That is exactly what happened in the Select Committee. For my sins, I sit on a surfeit of committees, including the Delegated Powers Committee, which drew attention to this very deficit in the Bill. So the question for the noble and learned Lord, Lord Falconer, is: since the Minister was questioned in the Select Committee by the noble Baroness, Lady Berger, in the weeks that have followed, has he had any guarantee from the Government that they will ensure that the Secretary of State by regulation ensures that the NHS delivers voluntary assisted dying services? When the Minister replies to the debate, can she cast some light on this matter so that we know whether or not the proposal that the noble Lord, Lord Birt, has put forward and my noble friend has opposed really has any basis in reality?
Lord Blencathra (Con)
My Lords, I was delighted to hear the noble Baroness, Lady Fox of Buckley, hit every nail on the head of everything that is wrong with the amendment moved by the noble Lord, Lord Birt. I shall speak to the amendments in the names of my noble friends Lord Mackinlay of Richborough and Lord Harper, and I have signed some of them. I have done so because the Bill as drafted, and as now proposed to be amended by the noble Lords, Lord Birt and Lord Pannick, promises choice while quietly engineering speed, centralisation and a single-minded pathway to assisted death. That is not a neutral design choice. It reshapes incentives, shifts resources and narrows real options for people at the end of life.
I will give three short examples of why the amendments proposed by the noble Lord, Lord Birt, are wrong, and end with a direct challenge to the noble and learned Lord, Lord Falconer of Thoroton.
First, the amendments would turn life and death decisions into a fast-track process. From first declaration to possible assistance, the clock can run down to 30 days, or as few as 18 days if death is deemed imminent. Panels must decide within 48 hours of referral. Reports are forced within 24 hours. Reflection periods can be cut to 24 hours. That is extraordinary. Courts take months to resolve urgent life issues. Prognoses measured in months are notoriously unreliable. Rushing assessments in this way risks premature deaths, misdiagnoses and inadequate exploration of reversible causes of despair. My noble friends’ amendments, including the ones that I have signed, push back against that compression.
Secondly, as others have pointed out, the assisted dying help service and the personal navigator create an asymmetric system. The navigator is designed to shepherd people quickly through the assisted dying pathway. There is no equivalent statutory guarantee that a person will get timely access to palliative care, hospice support, social services or mental health interventions. In practice, a patient could reach assisted death faster than they could gain access to pain control, a care package, meaningful social intervention or, as the noble Baroness said, a GP appointment these days. That is a perverse allocation of scarce resources and a distortion of choice. When one option is actively facilitated and the others are not, choice becomes a funnel.
Lord Falconer of Thoroton (Lab)
If the noble Lord will let me finish, then he can come at me. The noble Lord, Lord Hamilton, refers to the question of wrong diagnoses. We will come to that in the group that starts with Amendment 71; I do not want to go into it now. However, we are dealing here with a terminal diagnosis, with two doctors and a panel who have approved it. Doctors are not perfect, of course, but this is very much a safeguarded measure.
I apologise for not taking the noble Lord’s intervention straight away.
Lord Goodman of Wycombe (Con)
Imagine I were a poor person who went before the panel and opted for an assisted death, but said, “Were I rich, I would not do this; I would take my chance on the diagnosis being wrong”. If the amendment moved by the noble Baroness, Lady Berger, was passed, I would surely be ineligible, so her amendment is meaningful. If the noble and learned Lord believes that one should be able to choose an assisted death if one is poor, that is one thing, but, as my noble friend Lord Deben argued, one should be protected from having to choose it because one is poor. That is the difference.
Lord Falconer of Thoroton (Lab)
The way the noble Lord has put the question to me means that, plainly, this would be because of the illness, would it not? I want an assisted death because the illness is going to kill me. That seems quite a bad example.