Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence


Examination of Witnesses (Questions 1758 - 1759)

THURSDAY 13 JANUARY 2005

Rev Professor Robin Gill, Rt Rev Christopher Budd, Dayan (Judge) Chanoch Ehrentreu and Dr Khalid Hameed

  Q1758  Chairman: Good morning. This morning we have with us a group representing various sections of what is described sometimes as the faith communities. There may be alternative descriptions, but I will leave it at that. The system we have adopted is that I shall invite each of you, in such order as you care to embrace, to make short opening statements and then invite members of the Committee to ask questions to seek to deal with matters which may be of particular interest or concern to them. A full transcript is being taken of the help you give us and in due course, you will have an opportunity of reviewing that transcript to see whether it accords with what you thought you said when you were here, and eventually the corrected transcript will be appended to our report and become public property when the report is published in due course. Would you be kind enough to introduce yourselves and make your short opening statements in whatever order seems to be suitable.

  Rt Rev Christopher Budd: I am Bishop Christopher Budd from Plymouth representing Cardinal Cormac Murphy-O'Connor and the Catholic Bishops' Conference of England and Wales. I think you have received a written submission from that quarter. I should just like to make three main points by way of introduction and I have my script here, so I can leave that with the ladies. I believe that we all start from the need of compassion for those who are dying as common ground. However, I think we part company as between those who are pro life and pro euthanasia when working out what is acceptable as compassionate. We do not believe that killing someone, even when invited to do so, is the hallmark of compassion. Compassion, as the word suggests, is "suffering with", accompanying someone on a journey, the length of which is not in our control. The journey of course is open-ended as we know, the dying process. As we know, the way we come to die is highly variable. It is love that gives dignity to everyone on that journey, especially the person who is dying. My second point outlines four features of what I am calling the Christian moral tradition. The Christian moral tradition has the following moral wisdom for those accompanying the dying person. Firstly love is the overarching virtue, obviously construed in terms of compassion. Secondly, we do not intentionally kill anyone. Thirdly, we do not strive officiously to keep a person alive as long as technically possible through over-burdensome or futile treatment. Fourthly, we will always seek to sustain basic care to the end including feeding and hydration for as long as that is possible and in ways that are not burdensome. My final point, is that law must always seek to protect the vulnerable. The proposed change weakens that protection. It will also act as a corrosive force in my view in our society and gradually weaken the trust that is vital for patients, doctors, nursing and care staff and family members. Our experience of the abortion legislation has to be here a cautionary tale. I hope you do not mind me finishing with a quotation from the 1994 Committee recommendation " . . .we do not believe that these arguments" (that is those in favour of introducing euthanasia) "are sufficient reason to weaken society's prohibition of intentional killing. That prohibition is the cornerstone of law and of social relationships. It protects each one of us impartially, embodying the belief that all are equal. We do not wish that protection to be diminished and we therefore recommend no change in the law to promote euthanasia". I will finish there.

  Rev Professor Gill: I am Professor Robin Gill, I am the Michael Ramsay Professor of Theology at the University of Kent. I am here to represent the Archbishop and the House of Bishops. I just want to focus on two issues, both of which the Bishop has just touched on. The first issue is that of compassion. I think compassion is the point that unites all four of us, but I think it probably unites everybody here and all you on Committee. Compassion is deeply written into each of our religious faiths. It is central to all of our holy books. For us as religious people, compassion is directly related to our belief that God is a God of compassion and requires us to be compassionate in response to others. It is also deeply in our humanist tradition that even without a belief in God, the notion of compassion is absolutely central to our society. As some of you know, I made a submission myself for Dianne Pretty. I did it entirely on compassionate grounds. I thought that her case represented a very, very strong case indeed for voluntary euthanasia and if it was simply a matter of her and no-one else and not other people, I believe that this was as strong a case as you get and on compassionate grounds one should certainly reach out for it. When I made my submission, I also made it clear that there are differences amongst religious people and that the issue of legalising voluntary euthanasia is not simply a religious versus non-religious issue, there are divisions on both sides, but that for my part, I was not finally convinced by the case for legalising euthanasia. I was not convinced on compassionate grounds. In the end I concluded, as my Church has concluded, that more people, more vulnerable people will be made more vulnerable if we change the law in favour of legalising euthanasia. The second point I want to make is on autonomy. Autonomy seems to me to be absolutely central to medical evidence. I think all of us have come to accept slowly and some people with difficulty, that properly informed consent is absolutely essential to medical practice, that properly informed consent on the part of the patient, that the patient is properly informed, has time to make a settled choice, is given full information and is treated fairly and confidentially and, finally, is told of outcomes, is absolutely essential to good medical practice, whatever happened in the past. We make a distinction in our paper, and it is only implicit in the paper, between individual or personal autonomy, and what Lady Onora O`Neill has increasingly taught us to call principled autonomy, and I think there is a crucial difference between the two. Lady O'Neill argues from the secular side that a purely individualistic understanding of autonomy never does justice to medical ethics and is increasingly looking out of date. In her very powerful Reith and Gifford lectures she argues that a proper understanding of autonomy, an understanding of autonomy which goes back to Kant, and the rights of the individual always go hand in hand with the duty of the individual to other people. It is again on these grounds that I believe once we understand autonomy properly as principled autonomy, as involving other people and our duty to other people, then we have to look extremely carefully about changing the law in ways which I believe will finally make more vulnerable people, more vulnerable.

  Dr Hameed: My name is Dr Khalid Hameed. I am a medical doctor by training and I am a Muslim. I shall be brief in my submission to the honourable Committee and I have a few points. The power of life and death which this Bill proposes to give to a human being for snuffing out the life of another is the basic thought behind tabling this particular Bill. Throughout history we know that much human mischief has been prevented by our desire to reject the alteration of another human's physical existence for any reason whatsoever, except in the event of war or acceptance through qualified judicial processes. In spite of all the progress that we have seen in science and technology, humans have not lost any of their ability to kill with impunity. Any relaxation in law of measures to protect humans could lead to a slippery slope which could soon get out of hand. We have heard and read a great deal about the American experience of assisted dying and we should remind ourselves that amongst those who desired premature death or contemplated suicide very large numbers suffered from clinical depression. That is the experience from Oregon. The lesson from this is that though the disease in many of these patients was untreatable, the depression is very definitely treatable. Furthermore, large numbers are concerned about being a burden on their families and carers. They could therefore be burdened with the duty to die rather than a right to live. I have informed you that I am a physician by training and all we physicians have a belief in the Hippocratic Oath. I have spoken to a lot of my colleagues and many doctors in the profession are very concerned. Over hundreds of years, there has been a tradition of trust between a patient and a doctor, of being a confidante, of being almost like a family elder, a healer. For the families, the injection into this invisible halo around the head of the doctor of a shadow of an executioner, a lot of this will get very diluted. I spoke to many neurologists, as I am sure you have, and yesterday I was talking to somebody who is a leading neurologist in this town and like many other colleagues I asked him to recall any episode, any clinical story which produced miraculous recoveries and he was able to and he was equally concerned. So the patients in some of these stories recovered after a protracted period of hopelessness. What would happen to these recoverable cases, if there was a bottom line of economic prudence which could be applied to their cases? We have read a great deal about the end-of-life years and progress now has enabled us to challenge human suffering from pain, from breathlessness, from such like and there is to my mind a great hope for even greater progress in this area. What we need is probably a public debate on how to go about recompensing a lifetime of somebody's contribution to the community and to the country with tolerable end-of-life years. If the price is economic, perhaps the debate, the discussion should be about higher taxes or whatever it needs to keep these people and this is our modern duty and this is what our faiths tell us to do: look after those who are in need, not kill them. Islam, to which I belong, is very definite about human life and there are about 1.6 million people who follow Islam in this country. In Islamic bioethics, the physician has to render help regardless of the financial ability of the patient. He has no right to terminate human life, none whatsoever and there is equally a very clear instruction to all the followers of Islam, a very clear instruction against taking your own life. Thank you.

  Dayan Ehrentreu: My name is Dayan Ehrentreu. I am the senior judge of the ecclesiastical court of the Chief Rabbi. I think the Office of the Chief Rabbi has already put in a submission and from a religious point of view, I think it is made quite clear that the practice of euthanasia is contrary to the teachings of Judaism. Any positive act designed to hasten the death of a patient is equated with murder in Jewish law, even if death is hastened only by a matter of moments. The value of human life is infinite and beyond measure, so that any part of life, even if only an hour, is precisely of the same worth as 70 years, just as any fraction of infinity, being indivisible, remains infinite, no matter how laudable the intentions of the person performing the act of mercy killing may be, his deed constitutes an act of homicide. This is from a religious point of view. I think it is quite clear that certain arguments have been put forward and I should like also to mention some of the arguments which are put forward, especially as I understand one of the arguments is that the opinion of the religious view is a vast minority compared to the majority of opinions. One of the arguments put forward supporting this Bill has been the right of personal and patient autonomy. I agree the touchstone of a democratic society is the concept of individual freedom and personal autonomy. Despite contemporary society's commitment to individual liberty as an ideal, it recognises that the interest of the individual cannot be separated from the interest of the society at large. In fact, the previous Select Committee in 1994 concluded "We believe the issue of euthanasia is one in which the interests of the individual cannot be separated from the interest of the society as a whole". To legalise assisted suicide, that is euthanasia, will lead to direct or indirect coercion of terminal patients to express a wish to die. Legislation would place unfair psychological pressure on all ill patients. An ill person will, in all likelihood, find it difficult to make dispassionate decisions and may be pressured to terminate his life or her life feeling that they are a burden to society and a burden to family and friends. No-one should be placed in a position of having to choose whether to live or die. Hence, personal autonomy must give way to the interest of the society at large. The enactment of this Bill would also undermine, destroy and erode the doctor/patient relationship which is founded on trust. It could poison the atmosphere with suspicion and guilt. If doctors are authorised in special circumstances to assist in terminating the patient's life, they acquire an additional role alien to the traditional one of healer. Their relationship with all their patients is perceived as having changed and as a result, some may come to even fear a doctor's visit. For the interest of the society at large, personal autonomy in these matters must be set aside. We feel that it is essential to improve palliative care and make it available equally and accessibly to all who need it. Current demand far outstrips supply in the UK for palliative care, independent living support and hospice care. We believe that pressure for assisted suicide and euthanasia would be minimal if resources for palliative care and hospice care were increased. At present, people might request an assisted death in the absence of vital care services, undermining the principle of autonomy and not representing a real choice for patients. In fact, in July 2004, the House of Commons Health Committee report on palliative care and the 1994 conclusions of the Select Committee on Medical Ethics, together with the World Health Organisation, all recommended that governments demonstrate availability and the practice of palliative care before considering assisted euthanasia. The Office of the Chief Rabbi naturally is strongly opposed to this Bill. Compassion has been brought up. I think compassion is wanting the best for the other, having empathy with them in their suffering. Mercy or compassion entails staying at their side, offering good palliative care and through friendship helping them to recover hope, meaning and a sense of being loved. Another thing has been mentioned and that is dying with dignity or death with dignity. Judaism teaches that the human body must be accorded every sign of dignity in death as well as in life, but the struggle for life is never an indignity; the attempt to sustain life by whatever means is nought but the expression of the highest regard for the precious nature of the gift of life and of the dignity in which it is held. I just want to finish, that therefore each patient should be assured that whilst everything will be done to minimise pain, life itself will be honoured and never willingly terminated.

  Chairman: Thank you very much. There is now an opportunity for members of the Committee to ask your help for particular questions.

  Q1759  Lord Taverne: At the very first meeting we had, one example was put forward to us which I find very compelling which I should very much like to put to the panel. It was the case in the United States where a driver was trapped in a burning lorry. There was no possibility of extricating him and he was about to be burned to death and suffer a very painful end. A policeman was on the scene and he asked the policeman "Will you shoot me?" and the policeman did. It seems to me that here is a case where somebody certainly was guilty of intentional killing. It was not a case of war, it was not a case of judicial process and according to your arguments, the result seems to me to follow inexorably that that was morally wrong. Now, I do not see how that can be an acceptable conclusion. If what he did was morally right because he prevented unbearable suffering, then it seems to be that you have to admit that there are cases where killing, as you call it, bringing about death to end unbearable suffering, is morally correct. How do you answer that point, because it seems to me absolutely fundamental?

  Rt Rev Christopher Budd: Could I do the first reply to that? I do not think I would want to say it is morally acceptable: I would say it is morally understandable in that very tight situation which was not fabricated or brought about by anything but an accident. I would not want to take the guy to court for that. I would not want to endorse a direct killing of an individual.


 
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