Health: End of Life

Lord Low of Dalston Excerpts

Thursday 12th December 2013 Lords Chamber

[Lord Low of Dalston (CB)]

My Lords, I thank the noble Lord, Lord Dubs, for securing this debate, which may aptly serve as something of a curtain-raiser for the debates we will have on the Bill of the noble and learned Lord, Lord Falconer, when it comes to the Floor of the House next year. I particularly commend the measured and dispassionate way in which the noble Lord, Lord Dubs, introduced the debate, and, indeed, the generally restrained temper of the debate as a whole.

We do not have long, so I will make just a couple of points. The first, picking up on a point that the noble Lord, Lord Dubs, himself made, is that assisted dying and palliative care are often portrayed as antithetical to one another; indeed, we have heard echoes of this today. The supporters of assisted dying are depicted as heartless monsters who simply want to bump their relatives off for their money or because they have become a burden, but this is a travesty. Most people would want to see the alleviation of suffering that palliative care can bring exploited to the maximum. It is only when palliative care is inadequate or can do no more that they say an assisted death should not be ruled out as an option. Pace my noble friend Lord Hylton, nothing is being imposed on anybody.

I certainly do not accept the argument that the desire for an assisted death simply shows that the palliative care is not good enough, and that it would not be necessary if it was. That is one of those arguments that cannot be disproved because, by definition, the care could always be better. The fact is that in practice that is not always the case. In fact, assisted dying goes hand in hand with palliative care. Evidence from Oregon, where assisted dying for terminally ill adults was legalised in 1997, demonstrates that the vast majority of people who are assisted receive palliative care and support. The use of assisted dying legislation is very low and researchers suggest that the reason for this may be the high quality of care provided by Oregon’s hospices. Hospice provision in Oregon now ranks among the best in the country, but its growth has actually gone hand in hand with the legalisation for assisted dying rather than the reverse. Fears of assisted dying impacting negatively on palliative care have not been borne out; in fact, the opposite seems to be true, and assisted dying can act as a catalyst for the improvement of palliative care. But though palliative care may be excellent, there will still be some people who at the end of life seek assistance to die, and they should be allowed to do so.

My second point is that the views of disabled people are much more diverse than is represented by disability activists. No, that is too mealy-mouthed in an effort to avoid polemic; they are actually the opposite of how they are commonly represented. In a YouGov survey of 1,000 disabled people reported in the Times yesterday, almost 80% said that someone who helps a friend or family member who is terminally ill to die should not face prosecution. Asked what position they thought disability rights groups should take on assisted dying for the terminally ill, just under half said they should remain neutral, and a third that they should support a change in the law. Only 8% said that they should oppose a change in the law.

I align myself with Tom Shakespeare, himself a disability activist but not at one with the disability movement on this issue, when he says that,

“calm and evidence-based deliberation is usually more useful to disabled people than extreme rhetoric”.

He goes on:

“It seems to me to be inconsistent to support autonomy for disabled people in all matters except the moment and manner of their death”.

I agree with my noble and right reverend friend Lord Harries that there are occasions when it is right to override a person’s choice, but the decision must depend on all the circumstances. In my judgment, a case where a person is terminally ill, in great pain and wants to die is not one of them.