Examination of Witnesses (Questions 1760
- 1779)
THURSDAY 13 JANUARY 2005
Rev Professor Robin Gill, Rt Rev Christopher Budd,
Dayan (Judge) Chanoch Ehrentreu and Dr Khalid Hameed
Q1760 Lord Taverne: He should have
left him to be burned alive?
Rt Rev Christopher Budd: Well he would have
died, would he not? It is difficult. We have to set limitations
on what we can do in a situation.
Rev Professor Gill: I really would not take
that line. I would think what he did was right, but that is not
the point. What we are here to argue is whether it would be right
to change the law which allowed people to go round shooting people
in accidents which clearly we do not do, at least I do not think
we do. I hope the way the law would treat that person in that
situation is in turn with real compassion. I think there is plenty
of evidence to suggest that people who in desperation take the
lives of dear ones, who are in intolerable situations, intolerable
pain or distress, are treated leniently by the courts and I would
hope that would happen. Clearly, a law which said and it would
be a very clear instance of a difficult case making bad law, if
we were to change the law and say "In any future accidents,
the police are entitled to shoot drivers at their discretion whenever
they find them in a burning car". I do not think that is
how law could possibly work. What we are here arguing about is
not about the taking of life: What we are arguing about is whether
it is actually going to produce good benefits to society by changing
the law on euthanasia. That is a very narrow question.
Q1761 Lord Taverne: But it is a case
of unbearable suffering, which is what the proposed law is about.
Rev Professor Gill: It is a hugely compassionate
case and I would do exactly as the policeman did and I hope you
would too, but I would not expect the law to be changed to allow
that; indeed it would produce absolute chaos in society if we
really did allow the police the discretion of shooting people
in that context.
Q1762 Lord Taverne: You would not
say the police would be entitled to shoot, you would say it is
not contrary to the law in certain cases to assist someone to
die in a case where they are subject to unbearable suffering,
which is what the law is about. I do not see what the moral distinction
is.
Rev Professor Gill: It is not a moral distinction.
I am talking about whether you actually change the law in the
process and there are two ways of handling this. One is to say
yes, we actually change the law. The other way is to say for heaven's
sake, we show compassion and discretion, which is what we judicially
currently do in a situation like this and we do not want to end
up prosecuting police or doctors and so forth, if we possibly
can help it. If we do have to do it, then we must be merciful
and compassionate in those very rare cases where any compassionate
person would do as they did. It is the effect of changing the
law which is the central problem here and, as you know, I start
from a position of compassion, I start from a position of being
not just compassionate but in favour of Dianne Pretty, but what
I am still saying is that changing the law has implications which
actually are more damaging in my view, both to the law itself,
to the doctor/patient relationship and, I think, most importantly
of all, to other vulnerable people.
Q1763 Lord Taverne: May I just follow
this up a bit further? You say that it would have a damaging effect
on the doctor/patient relationship. In our visit to Holland, we
did not find that this was so, even in the case, for example,
of a Catholic hospice, not a secular hospice but a Catholic hospice
and care home. Those who had had experience of Dutch law, first
of all said they found no conflict with their religious background
to implement the law and, secondly, they said specifically that
the doctor/patient relationship had been improved as a result
of the law. So, on more practical grounds, there seems no reason
why the principle of relieving unbearable suffering—
Rev Professor Gill: I think you do know there
is quite mixed evidence. I thought you might raise this issue
and I am sure you already know the BMA's Medical Ethics Today.
I think it really is the most authoritative publication we have
in this area now in medical ethics. I am on the BMA's Ethics Committee,
I know how it runs, I know it is staffed by four full-time people,
there is no other comparable body in Britain and very few other
comparable bodies around the world. It has an enormous range of
experts on it, coming from very different angles and it has some
excellent lawyers too. When it publishes things, it publishes
them fairly and after a huge amount of discussion. If you look
up Medical Ethics Today which came out last year, and I
am sure you have it available to you, and you turn to their account
of the evidence on page 396, what you will find is that they present
factually the evidence from The Netherlands, from Oregon and from
the Northern Territories in Australia and in each of those contexts,
they document ambivalence.
Rt Rev Christopher Budd: Very briefly, on the
Dutch experience, I have not been to Holland so I cannot speak,
but the sort of input I am hearing from different quarters is
that there is a lot of dodging of regulations going on in the
Dutch scene. Obviously I can only take that on the grounds on
which it has been presented to me. In regard to the hard case
you present, and it is a very hard case, I think the old Catholic
distinction between objectively immoral and subjectively excusable
comes to bear on that, but that is getting technical.
Dr Hameed: I have not visited Holland, but I
have worked here in this country for more than 30 years and I
manage a hospital which is secondary/tertiary care here in London.
We treat a lot of cancer patients. In all these years that I have
been there, I have not had an official request or a personal request
from either a physician or a patient to terminate their life,
considering a lot of them have serious discomfort. Of course,
one does everything possible to make their lives as lacking in
discomfort as possible. On your earlier example of the burning
car or truck, if the policeman was there, one can assume that
an ambulance would not have been very far away and perhaps if
shooting is more dramatic and killing in that fashion, there could
have been large bolus of morphine which could easily have been
given to him to make him unconscious, if this was what was needed.
Certainly the experience that we have over here in the United
Kingdom in terms of pain and suffering is that, and I have asked
this question of many colleagues in the profession, the question
of the families asking for the patient to be put away does not
arise in normal practice. It can be clinical judgment, but certainly
request from the patient or the family.
Dayan Ehrentreu: What I should like to say about
this is the following. I do not think the Bill has been proposed
just for people who are burning in a car where there is a question
of shooting them or not; I am not going to go into what one should
morally do in this case or not. We do have a Bill here which is
for society and I have mentioned before already that the current
demand for palliative care outstrips the supply which is here
in the UK. I think it is for us before we even come to this Bill
to make improvement in proper pain control, good communication,
psychological support and then you will find that far fewer people
would consider asking for clinical help to die. Therefore I would
say that once this has been done, then you can start thinking
about what you want to do. At this stage, I think it is our duty
to improve palliative care and then we will find that the demand
will be minimal because the resources will be there.
Q1764 Baroness Thomas of Walliswood:
I wondered whether I could just continue the discussion about
the Dutch experience, in the light of what Professor Gill has
been saying. In Holland, as I am sure you are all aware, they
had a long period when the cases of euthanasia—and I use
that term, although it is a term which has very many meanings
but I hope that that will not confuse the argument too much—were
dealt with in the courts in an increasingly sympathetic way. It
was not until such cases had continued over a period of a number
of years, I think about 10 years from the first to the last, that
the Dutch actually approached the question of changing the law
itself. The law which they produced was in many ways very similar
to Lord Joffe's Bill. I do not need to go into the differences
and similarities but it has many points in common. I wondered
whether you felt, (and I am addressing this question to Professor
Gill, in the light of what you have said about the Dianne Pretty
case), that we need a period where the courts are engaged in this
subject because they have to be. (Because cases arise, where there
is more discussion, which this Bill has of course prompted, about
what you might call the rights and wrongs of the case.) I use
those words as somebody who is not professing any Christian faith,
although I am a member of a church, but I am not using it in the
religious sense. So that would give us time as it were, or give
society time, to come to a decision on the matter. There is some
indication that public opinion, (although we have just had some
fairly tepid support for this view given to us by a study which
we commissioned), is fairly sympathetic to the idea of assisted
suicide. Do you think that that process would be a useful one,
or would it not really change views in any particular way as to
the worth or not worth of changing the law?
Rev Professor Gill: Thank you for that. I think
I agree with almost everything you have said and I agree with
your assessment of the evidence; I suspect some of my colleagues
do not. I have been convinced for some time that there is general
public anxiety in this area and support and I think it is driven
both by a strong sense of compassion and also I think a strong
fear that medicine is becoming too clever at extending people's
lives. Both those things are thoroughly justified. Where I differ
is that having looked carefully at it, I am still convinced that
changing the law will make more vulnerable people, more vulnerable.
You say that we should move to the Dutch situation. In a sense
we already have. We have done it by a different route and I also
think that is correct. The Dutch had an agreement for 10 years
not to prosecute if guidelines were kept. There are worrying features
about this and they are extremely well documented features and
they were of great concern to the previous select committee. I
think if anything convinced people like Lady Warnock, who was
known for her sympathetic views towards euthanasia, if anything
convinced members who would otherwise have been sympathetic to
changing the law, it was precisely by looking at the Dutch experience.
They came to the conclusion, and this has been documented many
times since, that the Dutch have regulations but they do not keep
to them. They found first of all that it was a regulation for
the competent, that there was an agreement not to prosecute competent
people who requested euthanasia. What they found was that a third
of their cases were people who were not competent. They found
that they could not find any documentation at all for two or three
per cent of the cases. Members of the committee came back appalled
at the degree of mismatch between the intentions, what the Dutch
said they were doing and what they were actually doing; these
were seriously at variance with each other. I think this still
remains the case; there is plenty of documentation on this to
show that this still remains the case, that the law is about competence,
the law is about voluntary euthanasia but the practice goes well
beyond that. The law is about the terminally ill, but again the
practice goes well beyond that. I think it is that kind of slippage
which has been so damaging in terms of law. I think you are right,
I think we do have a situation where we have moved, but we are
responding as a society to the properly felt belief of the population
at large which does incline towards a change in the law, towards
strong feelings of compassion. I also believe that when people
act in really deeply compassionate situations, you do not go around
imprisoning them. That is already recognised in the courts and
is already recognised in the judiciary and there have been several
cases where people have either gone abroad and manifestly aided
and abetted suicide and have not been prosecuted, or they have
actively and intentionally taken the life of somebody who is terminally
ill and dear to them and desperate, where they finally have not
punished them. That, in effect, is what the Dutch did. In the
first instance, it is non-prosecution when you should be prosecuted
and in the second instance, it does mean taking it to the courts
but it has entailed being merciful in the process to people who
go down this path. So I think we have actually moved to the Dutch
situation already, but we have done it by a different route. I
think the Dutch tale is cautionary and this is why I think the
BMA evidence is so crucial to all of this: in every case around
the world where they have legislated for voluntary euthanasia,
there are considerable reasons for being disquiet about the outcome.
Q1765 Lord Patel: I should like to
pursue this point a bit further. You say that you felt that in
Dianne Pretty's case, her request for help to die would have been—I
do not want to put words in your mouth—justified?
Rev Professor Gill: Yes.
Q1766 Lord Patel: Do you think in
similar circumstances, you would feel exactly the same? In other
circumstances similar to those of Dianne Pretty would you feel
the same?
Rev Professor Gill: Absolutely; I think she
was a very courageous woman and she clearly articulated her case.
If we were simply considering her, I thought what she was asking
to happen was deeply reasonable. But that is not my point. My
point is that we are actually looking at changing the law in this
area. If we are looking for a change in the law, which affects
other people—
Q1767 Lord Patel: If the law were
so tightly drawn, then it would be exactly for people like Dianne
Pretty?
Rev Professor Gill: Well, your predecessors
on this Committee concluded that it could not be.
Q1768 Lord Patel: And you do not
feel that Lord Joffe's Bill, as drafted now—
Rev Professor Gill: I understand its intentions
and I share many of those, but I think you face exactly the same
problem as you faced 11 years ago, which is that you really do
have to be convinced that changing the law will actually help
people and not make things worse.
Q1769 Lord Patel: My supplementary
was to the Bishop of Plymouth on the comment you made about the
fact that we might go down the same slippery slope as the law
relating to the termination of pregnancy. Is it the slippery slope
issue that concerns you most? Again the same question: can the
Bill be tightened so that we do not go down the slippery slope?
Rt Rev Christopher Budd: If I could say something
about the nature of law, though I am most likely trying to tell
you things which you already know, the law relates to the common
good. I think this is very, very important. What Lord Joffe's
proposal seems to be saying means we will weaken the protection
of the vulnerable. I think that is what I hear. Once you do that,
you say you will slap a lot of regulations around it so that it
is not abused, but we know from the abortion legislation that
we are past masters at getting around regulations and extending
the boundaries. We like going back to parliament or anywhere else
for that matter and that is the slippery slope. Sometimes it is
scaremongering but it can be used that way and I think it is a
genuine risk that somehow we are going to lose that and vulnerable
people will be much more exposed to unscrupulous people. That
is the sort of dynamic which is set up and that would be my real
fear.
Q1770 Baroness Hayman: Two issues
really. I wondered whether I could ask Professor Gill's colleagues
whether they accept what I think is the basis of his argument
and it occurred a little in the Dayan's argument as well. This
was that this is an issue of balancing goods. There may be a specific
good for a tiny, or a very small number of people, whether it
is Dianne Pretty or the man in the burning lorry cab, but in public
policy terms, that is not justified, that would be outweighed
by the greater harm and whether it is that utilitarian public
policy argument that they are addressing, or whether we could
only talk about this when there was very good palliative care
for everyone and then the demand would be diminished. I accept
that, and certainly the evidence we have from Oregon is that very,
very few people would wish to avail themselves of this legislation,
if it were here, but that a few would, however good palliative
care is. So I wanted to try to tease out a little of whether the
absolutely fundamental, religious prohibition, for example against
suicide, ought to be translated into law or whether this would
be very difficult to frame in law? That was one issue. Could I
perhaps ask Professor Gill another question? It seems to me that
what he was actually arguing for was ex post facto decriminalisation
of the very hard cases; that may be an unfair designation, but
that is what it sounded like to me: that there were very hard
cases, but when people acted very compassionately in them, there
should be no way in which they were pursued through the courts
or imprisoned or subject to harm. I just wondered how he squared
that with the position of the person who was looking for assistance,
who needed that compassionate help and the pressure on them to
take a risk on what would happen to their doctor or their relative
after this event and turning those people into potential criminals
and whether that was a fair or unethical thing to do and whether
he was concerned about the lack of regulation about a practice
that we must believe goes on worldwide? Absolutely the last point,
Chairman, is this issue about vulnerability. I have been terribly
impressed by the evidence from Oregon that, far from it being
the poorest, least educated and vulnerable people who take up
assisted suicide, it is in fact the better educated and those
who are very assertive and in control of their own lives and used
to being in control of their own lives. I wondered whether you
would like to comment on that?
Rev Professor Gill: I do not think I am a utilitarian.
What I think I am doing, which is exactly the same as the Bishop,
is trying to balance individual good and the common good. I think
that lies at the heart of some of the most difficult quandaries
in medical ethics. It was manifest in the MMR debate, it has been
a problem constantly in the area of public health and this area
is no different. Balancing the two, or the tension between the
two, causes some of the most difficult problems in medical ethics.
I think that is what I am actually doing. I was not really arguing
for decriminalisation. What I was saying was that in effect decriminalisation
has already happened in at least one area: those who go abroad
and those who aid and abet others to go abroad to commit suicide
has already been decriminalised, even in practice. In the other
area, it is not decriminalised, and I think that is probably quite
an important safeguard and for the very reasons you say. The very
reason you give is that you do not want an open sesame that is
not entirely regulated. The answer is that it is not unregulated;
it is clearly regulated through the courts and clearly is at the
moment regulated through the courts. They are well able to distinguish
a Dr Shipman from a doctor who acts in good faith and gives somebody
what somebody else considers to be too much morphine. They are
well aware of the difference between the two already and I think
it is probably quite important that was keep that. Just lastly,
and I must not dominate this; on Oregon, again I think you ought
to look at the BMA evidence. What the BMA came out with was rather
important evidence pointing to the fact that in Oregon 44 per
cent of those interviewed—this was the Oregon State's own
review of it—who were going for voluntary euthanasia felt
themselves to be a burden to others. I think we have to be very
careful of this, but even rich and powerful people can be vulnerable.
Rt Rev Christopher Budd: I think it is crucial
that there is a rock solid principle at the bottom of any legislation
which says that we protect our citizens without any exception
of who they are, what state of life they have got to and things
like that. I think that is crucial. That is why I am very frightened
of this project, because I think once you take that away and start
making legalised exceptions, I think you are going to be surrounded
with regulations and things to make sure all holes are blocked,
but in fact it does not happen like that. I think it is a corrosive
thing over the years. I suppose both Holland and Oregon are still
fairly recent so it is a bit difficult to ascertain the long-term
effect. You have to be a person with long-seeing eyes and not
just short term, to say "This is a very safe thing and no-one
is at risk". Once there is a hole in the defence, all sorts
of people start being at risk. You might call me a pessimist but
I think the actual basis of law on principle is most important.
Dr Hameed: Of course we are concerned about
the slippery slope and the concern is that the right to live can
soon become the duty to die and the confidence of the people who
are taking those decisions, their state of health, their state
of mind, pressure of the family, pressure of the carers and a
culture, if they are going to start a new culture, where it would
be prudent and sensible and helpful to opt for ending life sooner
than the biological cycle. So, all those things are a matter of
concern.
Dayan Ehrentreu: I cannot comment on the Holland
situation or in Oregon, but I do know that in the vast number
of states of America, they have not accepted this, have they?
Perhaps I could come back to what the BMA actually said. They
were opposed to legislation because it threatens first of all
the nurse/doctor/patient relationship, it will frighten vulnerable
people and it will normalise the concept that some lives are not
worth living and all these run counter to the principles of healthcare
and the principles of medicine. I know some of the most distressing
situations arise from individual anxiety about maintaining dignity
at the end of life and this is combined with the concern about
the availability of effective palliative care. I repeat that I
think it is for us to see that we increase proper pain control,
communication and psychological support and then far fewer people
would consider asking for clinical help to die. There may be individual
cases, but we are not going to change the law for society because
of individual cases. I think it is important, and this is what
healthcare is about, to value life and assure patients that they
are going to be appropriately cared for.
Q1771 Baroness Jay of Paddington:
I wonder whether I could just comment on the points which have
been made, particularly by Professor Gill, about the position
of the 1994 Committee of which I was a member. I would say, and
there may be other members of this Committee who would not agree
with it, that those of us who have, in a sense, not necessarily
changed our minds entirely but certainly moved our positions from
those which were represented in that report, have largely done
so on the basis of the way in which the circumstances have developed,
for example in Holland and in Oregon where, particularly in Holland,
the use of the statutory approach as opposed to the rather piece-meal
regulatory one which you rightly described which was in place
a decade ago has made things seem much more secure. Certainly,
as a member of that Committee in the 1990s, and indeed of this
one, that would be the basis of the way in which my thinking has
moved. On the question of Oregon, I wonder whether you could reflect
on the point which I think Lady Hayman raised, but which you did
not particularly address, about the narrowness of the group of
people who do ask for assisted suicide there and the characteristics
that they have? I think Lady Hayman described them as being above
median educational average etcetera. The other point I would ask
you to reflect on is that I am sure we all agree that the BMA's
evidence is powerful but of course when we personally interviewed
the regulatory bodies in Oregon, the equivalent as it were of
those committees that you have mentioned, they did not report
any aberrations in the regulation and indeed had not dealt with
any problems which came to them as necessary for regulatory action
by them and that was a month ago. I think that is pretty up-to-date
information.
Rev Professor Gill: Their own review did make
that finding of the 44 per cent of people feeling that they had
been burden.
Q1772 Baroness Jay of Paddington:
No, sorry. I think you mentioned earlier—or perhaps it was
the Bishop—the question of regulatory slippage in Oregon.
It was reported to us that that had not occurred.
Rev Professor Gill: One of things which has
puzzled us about the evidence from The Netherlands, for example,
is that there have been two government commissions looking carefully
at their own practice and what those commissions have argued is
that there has not been any slippage during that time. I respect
that, but it seems to me that really is not the point. There has
not been any slippage because the situation really has not changed,
and the situation has not changed in the sense that they never
did, and still never do, stick to their own regulations. It is
quite true that there has not been any slippage in The Netherlands,
but they have not changed their ways either.
Q1773 Baroness Jay of Paddington:
What about Oregon?
Rev Professor Gill: The proof of that point
is that if you start asking "Do the Dutch confine themselves
to competent terminally ill people?", the answer is "No,
they don't and they never have done". Oregon is much more
tightly regulated and it is difficult to read from that one. There
is the evidence the BMA points to which is that 44 per cent of
the people coming for euthanasia feel themselves to be a burden.
I understand that, and I guess all of us as we grow older—and
I guess we are as a group getting older—will know that feeling.
I do hope we would be worried about it.
Q1774 Baroness Jay of Paddington:
What about Lady Hayman's point about the vulnerable? You have
several times used the expression "more vulnerable people
become more vulnerable". However, I think both Lady Hayman
and I were impressed in Oregon, that it did not seem to be vulnerable
members of society who came forward for this. It was a small number
and they were characterised in the way we said..
Rev Professor Gill: No and we need much more
careful monitoring and much more careful inspection of what is
going on in Oregon. We know what happened in the Northern Territories.
Q1775 Baroness Jay of Paddington:
No, I am specifically asking about Oregon.
Rev Professor Gill: There has been a lot of
information about Oregon, how good their palliative care is, how
developed that is. I want this group of people who feel they are
a burden to be investigated much more carefully. A lot of things
have to be in place before we go down this path of really being
confident that we have something which is secure and does protect
the law, doctor/patient relationships and other vulnerable people
in society more widely. One of the other pieces from The Netherlands
has suggested that evidence from interviews in old people's homes
in The Netherlands shows that people there are feeling extremely
vulnerable in a situation where they know doctors can take life.
It may be they are getting confused, it may be they are not themselves
clear about how the law works and all those things happen to older
people, but it is not clear that that group feels sanguine or
happy or comfortable about the wider implications of the law which
is directed, as you say, in Oregon to the very few. We need to
know a lot about Oregon at that level other than from the regulatory
authorities. The Netherlands is the most inspected area in the
world because it has had it so long, and I think there are, and
continue to be, the kind of worries that your committee identified
and clearly articulated and documented 11 years ago. I think they
remain.
Q1776 Bishop of St Albans: I just
want to say another thing about The Netherlands' evidence about
which you have heard a good deal of anecdotal comment from us
this side of the table. It just needs to be borne in mind that
the Jewish hospice that exists there, of course for obvious theological
and cultural reasons, is not allowing euthanasia. One needs to
reflect on that when one hears other forms of evidence and anecdote
coming from The Netherlands. I want to say something else, if
I may, which is that a number of you giving evidence have said
things like "Love is the overarching moral virtue" and
another quotation, I think from the Dayan, is "The value
of human is infinitely beyond measure". I suspect that within
those statements is an implicit view of the nature of the Almighty
that you have all made your statements about, the Almighty in
implicit form. I understand why, because I think it is based on
your desire to be enormously courteous and careful in circumstances
such as this. Would you allow for the possibility that if, I preface
it this way, if the Almighty is, might there be circumstances
in which we are all required in society to take note of what various
faiths have expressed by saying some truth is revealed? Would
you want to lay claim to that kind of statement?
Rt Rev Christopher Budd: May I comment first
on that? Yes, some truth is revealed and obviously I am sitting
here as one who actually accepts that and tries to live it. I
think these issues actually touch all human beings without exception,
irrespective of faith or lack of faith, as the case may be. Certainly
the Christian tradition, I suspect the Jewish and Muslim one as
well, tells us to go into the marketplace and engage in discussions
around some of the very vital human issues which are around. I
am obviously driven by my Christian faith and therefore you must
say yes, I am a very strong supporter of life and not changing
law which protects it. I suppose ultimately it is rooted in my
faith in God, but I think there are human issues which I can share
and join arms with a whole wide range of people of different faiths
and no faith at all and this is one of them. Again, if I can keep
coming back to this, the project is saying we can change the law
safely and still safeguard people against others who want to exploit
it and get rid of them to use the rather colloquial way of putting
it and I do not think that is possible. Once you have actually
broken the protection, no matter how many regulations you put
round it, we are devious. I am not saying that I am devious, but
human beings are devious and if I have a further thing to achieve,
I will find some way of getting round the regulations. I must
actually go to Holland and find out what is going on, because
I get different sorts of input from it, clearly from a Catholic
hospice by the sound of it; it is very interesting. The protection
of everyone in society needs that basic sort of premise of "Do
not intentionally kill". I know we instruct soldiers occasionally,
because they go to war and we also have our ethic of self-defence
and things like that, but this is unique in a sense. We are going
to say to our doctors "Given these circumstances, you may
kill". That is a road I would hesitate to encourage anyone
to go down.
Dr Hameed: I would certainly agree that life
is sacrosanct in all the faiths that I have studied and there
is no faith, including my own, which says that you can go out
and kill, with certain riders which have been mentioned. If we
are not very careful, we must appreciate that this could well
be the beginning of a further dilution of human faith and religion.
If you taking away the central plank of life itself from what
has been agreed, understood and accepted over centuries as God's
gift to man, it would be diluting religion as a civilising factor
in our daily lives. We have seen laws, we have seen countries,
we have seen dogmas, doctrines and it seems that the only thing
which has had a constant message for supporting life has been
religion. If we were to agree to a new law which gives away this
gift of life to humans to take, then it is diluting religion,
which can be construed as quite dangerous.
Dayan Ehrentreu: I should like to say the following.
Yes, you are quite right. I did not put forward the religious
point of view or did not stress it strongly because I understand
that one of the arguments has been that the religious view is
a minority and the vast opinion is opposed to it. From a religious
point of view, there is no question whatsoever: mercy killing
is proscribed as an unwarranted intervention in an area which
must be governed only by God himself. The life of man may be reclaimed
only by the author of life. Man does not possess absolute title
to his life and to his body and hence man's life and body are
not his to give. Therefore, as far as Judaism is concerned, we
regard human life as absolute and infinite and we consider a deliberate
termination of life as something prohibited. This is from a religious
point of view. What we wanted to put forward was, not looking
so much from a religious point of view, but for society as such,
the vulnerability of society and the very fact it is going to
affect the relationship between patients and doctors and nurses;
this is going to have an effect on everybody in society, not just
people who are religious. The fact that for some people their
lives are not valuable, they are not worth living, this concept
is a terrible thing and therefore, for this reason we oppose this
Bill most strongly.
Q1777 Lord Joffe: The Modern Church
People's Union in their submission say that they feel that the
Select Committee should be aware that there are also strong Christian
arguments in favour of euthanasia and that these arguments are
supported by 66 per cent of the members of the Church of England
who worship on a weekly basis and 84 per cent of Christians of
all denominations who worship once a month, that includes, Bishop,
the Roman Catholics laity as well. What is your response to the
statement of your congregations?
Rev Professor Gill: I think they got those statistics
from me. Wearing another hat, I am a social scientist and I spent
considerable time going through British social attitudes data
and extracted this information which is reliable information and
it is one of the reasons why I think that British social attitudes
data is to be relied upon. I think we must take that seriously
and not treat this as a simple religious or non religious issue.
It does divide religious people. It does not divide theologians
and church leaders as much as it divides lay people, there is
no question of that, but there are church leaders, the retired
primate of Scotland, and others in the past, who have supported
changing the law in this area and there are still one or two theologians,
both in the Catholic Church and in my own Church, who do as well.
These divisions are there and we must recognise that; it is quite
wrong to make this a religious/non-religious issue. Increasingly
religious people, this is the language we used in our own joint
submission, talk about life being given. Of course to us, as Christians,
it is God given, but I think to secular people, life is still
given, it is given by the people; you did not invent your life.
Human life is in that sense special and to be treated with care.
Intentional killing is not something any of us should be taking
lightly, whether we are religious or not. We have to keep this
firmly in mind and keep our eyes firmly on what we are actually
debating. What we are debating is whether the law prohibiting
intentional killing in a clinical setting should be changed. My
answer to that is in the end, despite all compassionate reasons
that have been advanced by others, no, because I fear that it
is going to make things much worse for people at large, for the
law itself, the doctor/patient relationships and especially for
other vulnerable people. So, I do not make it in that sense, a
strongly religious or non-religious thing, but there are reasons
why religious people have special reasons to be careful in this
area. However, we are not the only ones and I hope everybody has
special reasons for being careful in this area.
Q1778 Lord Joffe: I follow that.
May I come back on another important point which you raised? That,
if this Bill were passed, more harm would be done to some vulnerable
people than the benefit to the vulnerable people who benefit from
it. You say with confidence that you are satisfied that that would
be the position and I wondered what you based that view on? It
sounded to me as though it has to be speculation and I should
just like, before you answer, to touch on some of the other points
you raised. You raised the BMA and the BMA's very carefully thought-through
views. We had the BMA over here and it was conceded that there
were very different views within the BMA Ethics Committee and
the Chairman of the BMA Ethics Committee said that he supported
it. That was his personal view. You mentioned, almost in support
of the previous Select Committee on this subject, that even Lady
Warnock had this view. Well Lady Warnock has very much changed
her view and in fact she goes considerably further than we would
even suggest in this Bill; certainly three members have changed,
as Lady Jay has said. You referred to the views of the position
in Holland at the time that the last Ethics Committee went there.
Of course that was 10 years ago. We have been to The Netherlands
and we got a completely different impression; at least I certainly
got a different impression and I know some of my colleagues on
that Committee felt the same. The question of the slippery slope
was raised. The evidence in Oregon, in Holland and in countries
like Switzerland where evidence will be brought on the position
there, is that there is no slippery slope. Indeed one of the great
opponents of the Bill in Holland, Professor Zillig, accepts that
and has gone out to say there is no slippery slope. I would suggest
to you that there is a lot of speculation about what might be
the position, but when you look at all the speculation, you actually
find, or I think I found, that the position is entirely different.
Rev Professor Gill: Speculation and strong views
are on both sides of this debate and inevitably, when you have
not done something, you do not know the answer to it. All we can
do is look carefully and compassionately at the evidence of people
who have done it, I agree entirely about that, and also, I hope,
give some thought to what might happen. An old story which I was
always told by my philosophy teachers was that they put a fence
at the top of a mountain and nobody fell off the mountain. People
came and said "We do not need that fence. Nobody has fallen
off the mountain. We must take that fence away". Of course
that was sheer speculation on their part and not particularly
good speculation on their part but when you have something in
place, nobody ultimately knows what happens when you take it away.
All we can do is speculate and look as carefully as we can at
the evidence. You have had the evidence of The Netherlands, but
it remains the case in The Netherlands, and that was what worried
the previous committee, that they do not stick to their own rules,
they do no stick to their own regulations. They do still have
a large number of cases of people who are not confident and cases
of people who are not terminally ill and this remains the case.
It is not a slippery slope there; it is that they have always
flouted their own regulations. That was what worried the last
committee and it still remains the case. I am surprised you have
not picked that up.
Q1779 Chairman: We have been to The
Netherlands and have listened to quite a number of people, including
representatives of their professional bodies and so on. Whether
the statements you made about the facts there is correct or not,
I think is a matter that this Committee will have to judge in
light of the evidence that we have heard. If I may say so, the
contribution that I was hoping that you would give us would not
be dependent on what we might or might not have found in The Netherlands
or in Oregon, but rather from the point of view of the approach
that you have to the subject and whether or not this is a good
proposal. I think you must take it that not all that you have
said about what happens in The Netherlands is necessarily in accordance
with the evidence given to us.
Rev Professor Gill: I understand that, and they
clearly differ from the BMA in their Medical Ethics Today.
My principle is based, and I think all of us are based in a sense,
upon a concern for the good of the individual and a concern for
the common good of society at large. Anybody who makes dogmatic
claims about how we resolve those tensions is misplaced. Whether
these are on the basis of religious dogmatism or secular dogmatism,
it seems to me that there is a really serious tension involved
in this of how we balance the two together: the good of vulnerable
individuals, whom we are told, despite the best palliative care,
remain deeply disturbed about their condition—there is a
debate about whether there is pain there or not, but that is not
for me to say—but manifestly articulate themselves to be
deeply disturbed. How do we, at the end of the day, meet their
demands while still being concerned with society at large and
with the possible repercussions of changing something that has
been a foundation of British law, the prohibiting of intentional
killing and particularly prohibiting of intentional killing in
a clinical setting and how will that change impact on society
at large. Now that is the tension we are arguing about.
Rt Rev Christopher Budd: I have most likely
made my position clear by now I suspect. It is absolutely crucial
that you have a really firm foundation from which you can move
and "You do not intentionally kill" is that firm foundation.
Okay, Holland and Oregon have not been up and running in their
statute law long enough for us to say. I am a speculator, because
I really am very fearful that it gets more and more liberal, you
remove more fences. Once you lose your moral compass, you do not
know where you actually put the markers. It is not a psychological
thing, it is a moral thing, where our morality is and where we
actually take our stance.
Dayan Ehrentreu: I should just like to finish
off and say the following. I cannot comment on Holland because
I do not know what is going on there. What I do want to say is:
how do you assess whether people in Holland are not vulnerable?
It is a very difficult thing to assess. If a person says they
agree to terminate their life, how do you know that this decision
was not made because of certain coercion? Likewise, how do you
assess that it has not affected the patient/doctor and nurse relationship?
I think the vast Jewish community, certainly the traditional Jewish
community, is of the opinion that euthanasia is something which
should not be permitted and we strongly oppose this Bill. Compassion?
Certainly we are compassionate; it is part of our religion. One
thing which has not been mentioned is the following. If a doctor
is allowed to terminate somebody's life and he does it once, twice
and maybe a third time, he will become a person who has lost his
compassion and that is also something which is vital for medical
care. It is not just the trust, it is the care which he has to
give to his patients. On that basis, leaving alone the religious
aspect of this which is quite clear to us, we would certainly
oppose doing something where you are going to affect society.
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