Lord Deben
Main Page: Lord Deben (Conservative - Life peer)
Lord Harper (Con)
I am grateful for that intervention; it is a very good point. The importance of it is emphasised by one of the points that the noble Lord, Lord Birt, made in his opening remarks: that many people do not seek to make decisions on these matters until quite late in the process. If you were facing considerable pain as a result of your medical situation, not only might you not think about assisted suicide early on but, if it not available in your area, you may not have sought high-quality palliative care early enough. Again, that needs to be available at pace, as well as the choice of assisted suicide.
The second reason why I think these amendments are important is this. I do not know whether I am the only noble Lord to have thought this, but it does seem odd that what we are, or the noble Lord is, proposing here is a personalised service, I presume funded by the taxpayer—the noble Lord nods his assent—which would support somebody in a very personal, individual way to seek one particular outcome. But as far as I am aware, unless something happens in the National Health Service that I am not aware of, we do not offer a personal navigator to help somebody with their journey through seeking medical treatment that will actually help them live and live well, and it just seems to me a slightly odd sense of priorities that we are proposing to put in place a service that is only available to help somebody die.
Lord Deben (Con)
I wonder whether my noble friend could think a little bit about the money involved in this. I am sorry—it sounds a bit odd, but I do feel very strongly that we ought to talk about how much all this is going to cost and where that money is coming from. In the very unsatisfactory answers from the Minister, who gave the opinions earlier on in previous arrangements, I asked directly whether she would assure the House that this money was additional money, rather than money that would otherwise come from the National Health Service. I wonder whether my noble friend would think to himself about the extra cost that this would mean. Where would it come from, and why are we not spending it on a lively attitude, which is to help people when they are ill with better palliative care, instead of going in for this death concept?
Lord Harper (Con)
I am grateful for my noble friend’s comments, and he is right: we had an extensive exchange on this subject on a previous Friday, and I am sure the Minister will correct me if my interpretation of what one of her ministerial colleagues said was incorrect, but it was very clear when I asked whether the Government were going to fund anything in the Bill. The Minister confirmed that, if Parliament were to choose to pass the Bill, the Government would indeed fund it and make sure it could be delivered. But when I asked the Minister whether that funding would be extra funding from the Treasury or would be taken from other parts of the public services—I think this was in the context of the extensive debate we had on the proposals on the court system by the noble Lord, Lord Carlile—it was made very clear that that assurance was not given. I am afraid that the only conclusion I could come to, which was not challenged by the Minister—if she thinks I have got it wrong, she is welcome to intervene—was that the money would come from other parts of the public services.
I have to say for myself that, if this assisted dying navigator proposal were to be funded by taking money away from NHS services to pay for it, I think people would find that quite extraordinary. I personally would find it indefensible that we were, again, taking money away from services to help people live to pay for a service to help them die. That would show a very odd sense of priorities. When the Minister responds, because she is the only one who can answer this question, not the sponsor of the Bill, because he is not, as far as I am aware, responsible for His Majesty’s Treasury, I hope she can tell us—
Lord Harper (Con)
I think that the reason why the noble Lord, Lord Birt, has put down these amendments is that it is not clear, from what the Government have said or what the Bill says, where this service is supposed to be—I see that the noble Lord, Lord Birt, is nodding at that. If the sponsor of the Bill had set out in the Bill more detail about how it would work and where it would sit, if there had been a proper process, many of the amendments from people with concerns would need to have been tabled and we would be moving faster. It is because of that gap and that failure, which is the sponsor’s responsibility, that this is taking a long time. It is necessary scrutiny to get the Bill right. That is what the public would expect of us.
Lord Deben (Con)
My Lords, I think that we can clear quite a number of these things away by taking one central issue. The big problem about being in government is that it is not a single issue that faces you; it is a whole range of issues, and you have to get a balance between them. When we talk about cost, it is perfectly possible to say that there is a majority of people who want this thing, and there is a majority of people who want that thing. The Minister and the Government have to decide how to share out the money that is available between those things. That is crucial to any decision made by this House. My concern is that we are not facing up to that. This is a single issue being presented to the House as if it can make decisions about single issues, irrespective of the effect of the decision on all the rest of the single issues that people also have strong views about.
If you asked the public whether they wanted more money for palliative care, they would almost universally say yes. If you asked the public whether they wanted a National Health Service where they could get an appointment with their GP within a week, they would say yes. If you asked the public whether they wanted a National Health Service where there was someone who could help them through complicated arrangements, they would say yes. The problem for this House is that we have to decide, first of all, what burden these proposals place on the National Health Service, the judicial service and the Government as a whole.
Lord Markham (Con)
In terms of, hopefully, being helpful, it is in the impact assessment. It is £28 million or, as I said, 0.000175% of the NHS budget.
Lord Deben (Con)
I am perfectly happy to accept the intervention, but I understand why the noble Lord, Lord Birt, did not accept any intervention, as he might have found it difficult to answer the questions that we are asking.
The point that I am making is very simple and it remains: we have to make a decision always among priorities. The problem with this decision—and it is why this should have been a government Bill and not a Private Member’s Bill—is that, as a Private Member’s Bill, it is a single-issue Bill. It is promoted by people who want this to be decided irrespective of its effect on everything else that happens. That it is not acceptable, it seems to me, for the Government. The purpose of my comment is that it is not about how much the proponents think it will cost; it is about the effect of this over the rest of the National Health Service. If the Bill is passed, where is it going to fit? The Government really cannot get up and say that we are entirely independent. They have to tell us, if this Bill is passed, where they see it sitting, because the proponents of the Bill have not expressed this. What is the real cost; that is, not the sum of money, but the effect of it on the rest of the service provided? They also have to tell us how it will impact the essential demands that the public have for so many other things.
We can argue about what the public think about this Bill—I am pretty sure that they think about this Bill rather differently from what it actually is—but we have to recognise that the public also have very strong views about what money should be spent in other areas. The Government have to tell us, from their point of view, how much it will cost, what the effect will be on the other services provided, where it will sit if it is passed, and how they will overcome the problem that many of those who may be asked to support it have said that they will not. Those are things for the Government to tell us and, so far, they have been unable to put answers to any of those questions, which is the second reason—the other is the point that the noble Lord has just made about amendments—why we have constantly to go on arguing, in detail, about this Bill.
Lord Rooker (Lab)
My Lords, I will give a specific example. On 8 January, at col. 1416, the noble Lord, Lord Stevens, made a short speech, which consisted of about six specific questions. One of them was about the interaction of the health service and the Bill. Later that evening, I said to my noble and learned friend in intervention that he should come back within the next 10 days and answer those questions. The fact that he has refused to do so, and the suspicion being he has no intention of doing so, is why the amendments will keep being raised. That is basically the point that the noble Lord, Lord Empey, was making: there is a suspicion that they will not be answered. If we could do that, we could make more progress anyway because of the nature of the amendments that have been put down.
Lord Deben (Con)
My Lords, we have asked the Minister on several occasions to give us the information that I think the Government still need to give us: what is the cost of doing these things? The letter does not meet that. She has just said that there would be difficulties, but we want to know the cost in detail, because it is for the Government to help the Committee to make decisions. Could she please say now, and, if not now, give the undertaking that she will investigate the cost, so we know how to make a decision?
Baroness Blake of Leeds (Lab)
My Lords, I was just about to go on to the whole issue of funding, which many noble Lords have raised throughout this morning’s debate. The Government’s position is absolutely clear on this. Should Parliament pass the Bill, the Government would work to undertake development of the delivery model. Until the parliamentary process is complete, we are making no assumptions as to what the delivery model for an assisted dying service would be or what the role of specific departments in delivering the service would be.
Baroness Blake of Leeds (Lab)
I do not think it is extraordinary, but I am sure the noble Lord will keep expressing his point of view.
Lord Deben (Con)
The Government can perfectly well say that they do not have a view on this, but, for Parliament to make a decision, surely they have to tell us whether, if we made this decision, they would have to change the basic principles of the National Health Service. That is the only question that we must ask. The Government must be able to tell us whether, if we make this decision, that is inevitable.
Baroness Blake of Leeds (Lab)
I am sure that the noble Lord and others will find other ways of asking the same question. I refer to my earlier answer.
Lord Falconer of Thoroton (Lab)
They are fundamentally different, but the idea that removing the respiratory equipment does not involve some acts is not realistic. But I completely accept the proposition that they are different. On the legal point, there is some ambiguity about what the section means and whether it needs to be changed, but I am making it absolutely clear that, from my point of view and that of the promoters of the Bill, it is most certainly not outside the broader founding principles of the NHS.
Lord Deben (Con)
I accept that very much from the noble and learned Lord. The question I asked, because I think it important, is for the Government to say what the legal situation is, which they have a duty to tell us before we can make the decision. I entirely accept what the noble and learned Lord said about his own position, but this is a question for the Government, if they are independent of this. They have a duty to provide information to the House before we can make these decisions.
Lord Falconer of Thoroton (Lab)
The broader question of whether this contributes to healthcare is for each of us to make our own judgment about. If noble Lords take the view—I am talking not about the legal issue but the broader issue—that this is wrong and contrary to the basic founding principles of the NHS, they can vote against the Bill. But if Parliament passes the Bill and says, “We are happy that that is the position”, it is saying that it is an acceptable part of healthcare.
Lord Deben (Con)
The noble and learned Lord really must accept that there is a problem with this being a Private Member’s Bill. He can say what he likes about the Bill, and I acknowledge and accept his absolute honesty about it, but the Government have the role of informing the House. Indeed, they do it: every time we have a debate, the Minister gets up and says that this or that would be difficult or awkward, or would be contrary to the European Court of Human Rights. I am only asking that they do that job on this. Is what is being proposed contrary to the founding position? Would the law have to be changed? It is up to the Government to tell us. We can then decide whether that matters.
Lord Falconer of Thoroton (Lab)
It is for Parliament to decide whether it is willing to pass the Bill. If Parliament is willing to pass the Bill, there may be the need for the legal change that the noble Lord, Lord Stevens, referred to. Whether or not you are willing to make the change is, for the reason I have said, a matter of what you think is the principle. Those are the only remarks that I need to make in relation to that, and I invite the noble Lord to withdraw his amendment.
Lord Falconer of Thoroton (Lab)
I apologise; I should have answered that request. I do not want to write; I want to tell the noble Baroness the answer now. The Bill, in the places that I have indicated, says that the panel, the two doctors and the assisting doctor must be satisfied that the consent is informed. If the position is that the person who wants the assistance, or is about to get the assistance, is misinformed in the way that the noble Baroness described, that would not be informed consent. For example, having been subject to digital information that is completely wrong or misleading in what it says would not be informed consent. As time goes on, no doubt doctors and others who have to satisfy themselves that the consent is informed will have to take steps to ensure that the patient’s understanding is right.
This goes to what the noble Baroness, Lady Finlay, said. Sometimes, people do not take in what you are saying. Some people take in the wrong thing. Other people are, in the back of their mind—you cannot know this—thinking of something that is completely wrong. It is for the doctor or the panel in every case to satisfy themselves. It is explicit in the Bill that consent must be informed.
Lord Deben (Con)
To clarify one issue, the noble Lord, Lord Wolfson, suggested that the Government should answer the question about whether they believe that these circumstances are covered. The government spokesman kindly passed it back to the noble and learned Lord, the proposer of the Bill. Could he please explain why it would not be sensible to put in the Bill precisely what would normally be expected of the doctor? This is merely because we would be much happier if that were there, and it would take it away from the problem the Minister does not want to touch himself, in case in some way he gets infected by not being independent. Why can he not just accept that, if what he says is true, putting it in the Bill does not alter it but makes people much more secure?
Lord Falconer of Thoroton (Lab)
I listened very carefully to that. I indicated previously, in relation to powers of attorney, for example, that it would be worth putting it in. First, I am not sure what “it” is. Secondly, “it” is there: the key is the words “informed consent”, which nobody has any difficulty in understanding. It may have a particular implication in a particular case, and you have to give people flexibility in relation to what they say, because it will depend on the circumstances. If I knew what “it” was, I would put it in, but it is just not that simple.
Lord Deben (Con)
My Lords, this is the point where we come to the heart of the reason why I find this Bill so difficult. I know what sort of society I have spent my life trying to produce and work for: a society that cares, particularly for the vulnerable. I was accused by the noble Baroness of being patronising the other day. If it is patronising to defend the vulnerable, I plead guilty.
Baroness Jay of Paddington (Lab)
My Lords, I must respond to that. I certainly did not accuse the noble Lord of being patronising. I said that I thought there were difficulties in health policy when we accepted some of the old—and, now, more old-fashioned—concepts in which the medical profession seemed to be patronising. I was not referring to parliamentarians.
Lord Deben (Con)
I will not take it, therefore, as I did on the occasion when she mentioned it.
What I want to say to the Committee is simply this: many people in many institutions will be tempted to look at the price of death as against the price of life for those who are very seriously ill. There is no doubt at all that all the countries that have already enacted laws of this kind have found this to be a problem. They have all found the difficulty that, for people who have been given about six months to live—even if that is a false diagnosis—there is a tendency to say, “Well, they’re going to die anyway”. A number of noble Lords and noble Baronesses who support this Bill have said that.
I want a society that cares about those people right to their last moment in which they die. That is what I think we are here to do. I hope that does not sound too sentimental, but this is about the difference between kindness and love. Love is something with a backbone that cares for people right to the end and makes sure that they do not feel a burden. We cannot do that for everybody, but the trouble with this particular Bill is that it does not make it absolute and determined that we do look after people and that we find out whether they feel a burden and help them not to feel a burden.
Any of us who has had loved ones who are ill know that, even if they are not seriously ill, the very first thing they do is feel a burden—a burden on their spouses and on other people. That is what decent people do. Other decent people spend their time trying to make sure that they do not feel a burden. Other decent people try to see what is at the heart of their misery—that is the phrase that is used. We should be here to try to remove the misery from people in their last six months, just as we should throughout the whole of their lives. Those who are proposing this Bill seem so committed to getting it through somehow that they think we must not in fact consider what the rest of society is.
I know that the noble Baroness, Lady Blackstone, hopes to interrupt me, but, before she does, I will just say this. I am not one of those Conservatives who believes in the kind of free market operation where you do not deal with things at all. I am, in that sense, a socialist; I believe in the individual in society. The whole problem with this emphasis on autonomy is that it is not acceptable unless you see the individual in society. The trouble with the Bill is that it tempts those who find it more convenient to allow people to kill themselves because it is more expensive for them to continue to live.
Baroness Blackstone (Lab)
I was not going to interrupt the noble Lord, but his last remark does lead me to interrupt him. I do not think there is anybody who backs the Bill because they think it is more expensive for people to continue to be treated. Nor do I think it is the case that those people who back the Bill are in some way unaware of the societal context in which people live and die. We are all aware of that.
Moreover, some of the comments from those who oppose the Bill or are trying to introduce more amendments to it neglect the fact that most doctors—nobody is perfect, of course, but most doctors—are fully aware of their obligations as members of society and of a caring profession. They spend a lot of time trying to help and advise their patients not just about their immediate medical needs but their other needs. It is certainly the case that most general practitioners will help a patient who is suffering because of poverty. They will find ways in which they can access funding and support the patient in terms of their worries about being a burden. So I do not think anybody who supports this Bill suggests for one moment that we should accept that a patient who feels they are a burden should die just for that reason. The reason they do think they should die, if they want to, is that their suffering is intolerable. That is what lies behind those who back this Bill’s motivation.
I hope the noble Lord will accept that and understand that there is nothing in what we are saying which suggests that we simply want people to be able to die because they need to be autonomous. We want them to have the choice to be able to die, if that is indeed their choice and if the circumstances which they are in are such that their suffering is enormous. Most of us who back the Bill have experienced this in our own lives and seen what happens in those circumstances. I have sometimes wondered, in listening—I have done a lot of listening and not much speaking on this Bill—that some of the people who raise all these amendments have not had the experience of seeing the terrible suffering of people who have already been diagnosed as terminally ill.
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 Kamall (Con)
My Lords, it has been a long day at the end of a long week for many noble Lords, so I do not seek to make a long speech. But before I respond to the debate on this group of amendments, I want to thank all staff from across the House who have worked extra hours to ensure that we could be here today and at this late hour. We really do appreciate it.
I thank the noble Baroness, Lady Berger, for introducing the amendments in such a clear and, more importantly, concise manner. As my noble friend Lord Blencathra said, the principle behind this group is very similar to that behind the last group: what is being sought is that doctors should seek to establish whether those who are terminally ill, and who have been given a prognosis of six months or less to live, are seeking an assisted death for those reasons only—their terminal condition—and not material factors.
My noble friend Lord Markham explained why other motivations are relevant, could be relevant or could be reasons for people wishing to die or seeking an assisted death. Contrary to that, the noble Lords, Lord Mawson and Lord Carlile, referred to misunderstandings and pressures, particularly on people from black, Asian and other minority ethnic communities. It reminds me of a comment that the noble Lord, Lord Rees of Easton, made at Second Reading—a man who spent all his life working with black communities in Bristol—who said he was concerned about the impact of this Bill on black communities.
The noble Baroness, Lady Grey-Thompson, has also spoken of her own very real experience and concern for people in the system, if the motivation is not purely because they are terminally ill but might be because of other factors. I know that my noble friend Lord Deben shares these concerns. I just gently remind him that he is not as unique a Conservative as he believes he is; all Conservatives want a better society. In fact, most politicians from all parties go into politics because they want a better society. We are on different Benches simply because we disagree on how to achieve that. Conservatives would probably say that the state is not the same thing as society.
Lord Deben (Con)
I am sorry if I misled my noble friend. I merely meant that you can believe in the individual but you have to believe in the individual in a society, and you cannot take the extreme view that suggests that the individual is on their own. No man is an island.
Lord Kamall (Con)
Indeed, and in fact many classical liberals and libertarians understand the individual’s role in a wider society. But that is not the basis of this debate, and I digress too much. I will return to the group of amendments.
I know that the noble and learned Lord, Lord Falconer, understands the concerns of those who have raised issues about minority communities and people being stuck in the system. But I also know that he has already made his view clear about the principle of seeking to exclude some of those other principles—if I am incorrect, I am sure he will correct me. So I suspect that, given the strength of feeling, we will return to these amendments on Report.
Given that—I understand that the Minister may not be able to answer all the questions now and we accept that he or one of his colleagues will write to us—we have to understand how the Government envisage how a person’s motivation beyond their terminal condition could be established. That is the crux of the matter. How do you establish that if you can justify it only on the grounds of terminal illness, not other motivating factors?
For example, what work, if any, have the Government or NHS England done to try to understand that? One assumes they may have to draw up guidance for this one day. Have the Government, or anyone in government, looked at how other countries have handled this issue, whether they do handle this issue, and what would have to change? We spoke earlier about the foundations of the National Health Service and what might have to change in guidance for many of the practitioners. Indeed, what training would be required?
As my noble friend Lord Deben has often said, this goes way beyond just the Bill. It will affect the Department of Health, the practitioners and the legal system. These are questions we need the Government to answer. They can still take a neutral position, but they have to understand that noble Lords seek to understand the implications here for government, the costs to government, and how that will change.
I understand these questions are in depth and recognise that the Minister may feel it is slightly unfair. I do not expect all the answers now. But it has been a constant theme throughout the debate and the many days in Committee that we need better answers from the Government. That is not a party-political point; it is purely that we want to see the implications of this on government: what extra costs there will be, what guidance will have to change and, however the Bill finally turns out, and in whatever form it reaches the statute book, how the Government will deal with that. I suspect that, for many noble Lords who are torn the Bill, that might be the deciding factor on how they vote at the end of the day.