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Lord Carlile of Berriew: My Lords, I, too, join in the applause for the chairman of the committee, the noble and learned Lord, Lord Mackay of Clashfern. His wisdom, his judgment and just occasionally his Scots instincts made possible a task that most of the rest of us would have found wholly impossible.
In the evidence before the Select Committee in this House and elsewhere, I have heard abundant repetition of a proposition—that death by choice somehow provides a more dignified end to life than death by the process of nature, a process which, of course, includes disease. To that proposition, I for one am unable to subscribe. I take that view not from any religious viewpoint—if anyone detects my religious viewpoint, would they please kindly let me know what it is, because I have been struggling to find it for the whole of my life. If I ever find it, it will probably be on my deathbed, if I am given the opportunity. My viewpoint on this matter is framed, to an extent, by 10 years' experience as a lay member of the General Medical Council—hardly a religious experience; possibly a paradigm utilitarian experience; certainly an experience which, if you were on the road to Damascus, would make you likely to turn off into the nearest service area.
My view is that a new law on this subject, whether it relates to voluntary euthanasia or assisted suicide, must achieve two ends if it is to stand the test of being a good law. First, it must have ethical integrity for any profession that is involved, whether they are doctors, lawyers or, possibly, a new profession of thanatologists—why should doctors be involved in this? Secondly, it must have legal certainty.
I turn to the first of those, ethical integrity. I do not believe that any ethical framework concerning voluntary euthanasia or assisted suicide could be accepted other than under the heading of "therapeutic benefit". Therapeutic benefit can be judged objectively. It commonly is judged objectively in the everyday work of doctors by their peers, and occasionally even the doctors will allow their therapeutic benefit to be judged by us, the patients. As between human and human, therapeutic benefit in carrying out death by a deliberate act can never be justified objectively if there is an alternative available.
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I have read all the evidence and I have listened to some of it. In every case—and I mean every case—there is a therapeutic alternative available. It may not be a perfect alternative, but there will be an alternative. I am told that the alternative may not be one that we would choose, but I do not seem to remember being given the choice of being born. We do not exercise true choice in many things that happen in life although we may often delude ourselves that we do.
So in therapeutic benefit, at the very least, in every case there is some type of end-of-life therapeutic medication that can remove the pain. We have to face that. If once in a million cases there is a case in which the therapeutic benefit cannot remove the pain, is that the hard case that makes for a bad law? I do not believe so.
Secondly, I turn to legal certainty. If these cases are allowed to proceed under even a modified version of the Bill of the noble Lord, Lord Joffe, they will from time to time lead to homicide trials. I am basically a criminal law practitioner. I know that we are regarded by our commercial practitioner colleagues rather as the physicians sometimes view the orthopaedic surgeons in the medical world. However, we wrestle on a daily basis with asking ordinary people—juries—questions that can be difficult to address. What is the question that they would have to address in this area? It would not be, "Are you sure that this is homicide, before you can convict?". Rather, it would be, "Are you sure that there is not some therapeutic benefit that could be given before you can convict?". It is inevitable that many cases of homicide would be allowed to slip through the net if this kind of Bill became law.
I turn to the question that I have asked myself many times—why do people want death in the way that is prescribed by this type of legislation? Can we be sure that they are exercising their free will? How on earth can we be certain that there is not undue influence? I found that the Dutch evidence, which I heard in the Netherlands, extremely unconvincing. One of the figures that comes from the Dutch evidence, from research that was published this year, is that 50 per cent of cases are not reported by doctors who carry out voluntary euthanasia although they are obliged to report every one. Why do they not report about 50 per cent of the cases? Because they know not what they do in many of those cases. We cannot brush those figures aside. I fundamentally agree with my noble friend Lord Taverne when he asserts that the Dutch experience is not one in which we have confidence. Having heard the evidence there, I have very little confidence not only in what doctors do in Holland, but in the way in which the Dutch authorities seek to ensure that the practice is carried out carefully.
I would add this on assisted suicide. Some noble Lords, some who are present today, have a particular interest in mental illness. Some of us, unfortunately, have had to deal with mental illness in our own families. It is a very troublesome thing when you come across it for the first time. It becomes a very important issue in your life once you begin to understand it. It leads me to ask myself, why do people assert that they wish to have their life ended by voluntary or assisted
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suicide? My belief is that in many cases it is because they are ill that they are not able to make the essential judgment that is required for the decision to be one which is governed by sound medical ethics and certain law.
If we enacted legislation along the lines suggested by the noble Lord, Lord Joffe, we would send a completely false message about the state of the law in this country and the ethical judgments that we would wish to impose on doctors. I am against it.
5.47 pm
The Lord Bishop of Oxford: I very much respect the serious intentions of the noble Lord, Lord Joffe, and the care that he has taken with the Bill to try to limit any possible damage. I should also like to say to the Select Committee, as a person who was not a member of it, how valuable the report was. It was a model of clarity and helpfulness.
It has been suggested or hinted a number of times that the main arguments against the Bill are on religious grounds. There are some religious arguments, and it may be that some of them will strengthen arguments of another kind. But I know that the right reverend Prelates the Bishops of St Albans and of London, and myself, believe that these are rational arguments that can be considered by rational people whatever their religious views.
A leading article in the Guardian this morning said that the bishops,
I feel like writing to the Guardian and asking if it would please assess the rationality of our arguments. That is very much what I hope your Lordships will do.
I believe that there is a fundamental philosophical flaw behind this Bill which, indeed, would be behind any successor Bill. It concerns autonomy, which cannot be taken as the overriding principle. In some respects all noble Lords would accept that. But Professor John Harris, who has been very influential and been quoted in the Select Committee report, stated:
"It is only by the exercise of autonomy that our lives become in any real sense our own. The ending of our lives determines life's final shape and meaning . . . when we are denied control of the end of our lives, we are denied autonomy".
What worries me about that quotation is that there is a sense that if we are denied autonomy—the ability to make a choice at the end of our lives—our lives somehow lose shape and meaning. I suggest that our lives have just as much shape, meaning and value when we are in positions of total dependence on other people. For much of our lives we are dependent on other people and may not be capable of making significant choices at all—in the womb, as a child, through periods of sickness, and perhaps for quite a long period at the end of our life. A loss of autonomy does not signify any loss of meaning or value from our lives.
Here, we need to face the fact that, as was once put rather brilliantly, mind is a social reality. We become persons in relation to other persons. There is a western
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idea that has been with us since certainly the 18th if not the 17th century: we are essentially human beings only if we are standing on our own and making heroic choices. That is a totally flawed understanding of what it is to be a human being. We are interdependent, there is mutuality, and our meaning and value are discovered just as much through other people's attitudes to us when we are dependent as they are in the choices that we make.
I know that the noble Baroness, Lady David, felt rather insulted by the reference to people with strong personalities wanting to be in control of their lives. I point out to the noble Baroness that that was in the Select Committee report as evidence of the kind of people who are seeking this measure. In contrast to that, we need to pay attention to the point in our lives when we are dependent on others. We should realise that at those times we in no way lose meaning or value.
There is time for only one other point, which is in reference to the well known "policeman's dilemma". A motor accident leaves a lorry driver trapped in his burning cab. He cannot be freed and he asks a policeman to shoot him before he agonisingly burns to death. Many of us here—I am certainly one—would not judge a person in that situation to be wrong. But Professor Harris says:
"If we concede this case, then we concede the principle of assisting death in extreme distress and where the condition, as the lorry driver's was, is clearly the terminal one".
I do not believe that to be true. There are certain boundary situations where agonising choices have to be made. There are certain exceptions. But you cannot take from those exceptions general principles of prescriptions and laws. St Thomas Aquinas gave a well known example. He said that if a person who is starving to death steals when there is no other way of obtaining food, he is not guilty of theft. That is a similar boundary situation but we would not dream of legislating for that. The fact that we concede the policeman's dilemma should not bemuse us into thinking that we should therefore legislate. The point about exceptions is that they really are exceptions, and we do not want to legislate for them.
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