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Baroness O'Cathain: My Lords, even at the position of speaker number 39, I feel compelled to join everyone else in congratulating the Select Committee under the wise chairmanship of the noble and learned Lord, Lord Mackay of Clashfern. It has done a brilliant job.

Today, we are debating one of the most important issues that could ever come before this House. It is an issue of gravity that affects every single inhabitant of this country; namely, whether we should agree to determining the length of our lives. Its importance is obviously recognised by this House by the very large number of speakers. In my experience, it is a far greater number than for any other non-government issue.

The proposed Bill would be profoundly contrary to the Christian faith and to the basic values shared by British people of all faiths and none. As an aside, I have been advised not to mention the Christian faith in this House. I regard that as almost unbelievable. Over 70 per cent of the population has stated in the last census that they are Christian. As has already been stated, that colours our view. The issue we are addressing is whether there are any circumstances in which we should authorise doctors to help people to end their lives.

I unequivocally oppose the demand for a euthanasia Bill. That is really what we are talking about. Patient-assisted suicide is just the beginning, as has been stated many times. If we start down that road and agree that doctors can help patients to kill themselves, the Voluntary Euthanasia Society would no doubt maintain that we have accepted the principle and that voluntary euthanasia is just an extension of that principle. I pray and hope that this House will reject the call, and most rigorously.

The psychologist Neuhaus, quoted in W J Smith's book Forced Exit published by Random House, New York, in 1997 put the point succinctly and suggested that those who support euthanasia,

Our postbags make so many points, but some are made by almost everyone. They include, first, that this is a huge step in the direction of total breakdown of trust between doctor and patient, a point made by doctors and patients; secondly, that elderly people are frightened; thirdly, that the frail fear intimidation; fourthly, that some feel that they would have a duty to remove the burden on their families; fifthly, that those nearing the end of their life feel guilt that they are spending on long-term care the inheritance earmarked for others; and, sixthly, anxiety that the parlous state of the National Health Service's finances could result in pressure being put to end the expense of care. I have just listed those points; the noble Baroness, Lady Wilkins, elaborated on them in a most moving speech.

Interestingly enough, I have had no letters supporting the proposed Bill. The BMA alone wrote to me stating that it was neutral, but how democratic was the vote? Yes, we all had a letter last Saturday trying to justify the stance, but for me it rang pretty hollow.
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Briefly, I shall focus on personal autonomy, which is regarded as the kernel of the issue by those who want to see the law changed. Personal autonomy is a highly dangerous concept unless it is properly understood and applied to the right issues. I have always been a believer in people taking charge of their own affairs. Individual choice and personal responsibility are important, and as economic concepts they have served this country well. But one cannot apply economic and political concepts uncritically to the moral and religious sphere. When we try to apply personal autonomy to the transition from life to death we really are trying to play God.

The right reverend Prelate the Bishop of Oxford quoted the statement of Professor Harris, one of the witnesses. I too picked up on it when I read the report. The ending of our lives determines life's final shape and meaning, both for ourselves and in the eyes of others. When we are denied control at the end of our lives we are denied autonomy. The professor implies that if we cannot control our death we are not dying well. I refute that totally. To state the obvious, we are all going to die one day. A good death does not consist of tailoring your departure from this world to your own personal wishes. What determines one's life's final shape and meaning—to use Professor Harris's words—is how one handles the dying process, which involves how one lives spiritually, physically and emotionally during the process rather than how one evades it. To argue for assisted suicide or euthanasia on the grounds of personal autonomy is to oversimplify the problem.

Another witness, Dr Rob George, a consultant in palliative care with a great deal of first-hand experience of people dying, defined autonomy as:

He described people who wanted to end their lives as,

The view of Dr George is on a par with many of the witnesses who had similar experiences of the dying process; namely, that those who want to decide when they die are generally people whose suffering stems more from the fact that they know they are terminally ill than from actual symptoms. We need to recognise that a request for assisted dying, like an attempted suicide, is normally a cry for help, and that is how we should treat it.

Severe depression is often a concomitant of terminal illness. It can be treated effectively, as I know from personal experience. I spoke about that on 25 June 2003 at col. 370 to support my noble friend Lady Knight in the Mental Capacity Bill. Since then, I have had additional sad experiences of the early deaths of my two younger and only siblings. The inevitable deep sadness for me was hugely compensated for by the fact that they both had "good" deaths. Frequently, the dying process is a true period of closeness and an opportunity to show love and respect; a period of reconciliation both with fellow human beings and with God. All of that is of great benefit to both the dying and to those who are ultimately bereaved. Yes, I have
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witnessed only happy, calm and peaceful deaths, but one cannot overemphasise what solace and good memories result.

The Select Committee's report states that Britain is the world leader in palliative care; however, we know that not enough money is spent on it. It is a disgrace that in a nation blessed with wealth like ours anyone should die in pain. Surely a wish for euthanasia is not a longing for death but a fear of pain and suffering. Barrelling headlong into a euthanasia society is completely the wrong approach. The real, humane solution lies in improving palliative care.

We have day-long debates and three-inch thick reports on a euthanasia Bill. I hope that we shall resoundingly throw out the proposal for such a Bill and hasten the preparation of and investment in just as much time and effort in a palliative care Bill.

8.9 pm

Lord Carey of Clifton: My Lords, debates in your Lordships' House are usually important, but that on the report of the Select Committee and its implications must surely rank as among the most crucial, as far as the most vulnerable and helpless people are concerned. In contributing to the debate, I wish to dissociate myself from the view that those of us who disagree with the thrust of the intentions of the noble Lord, Lord Joffe, have a higher view of human dignity than those who present the case for assisted suicides and voluntary euthanasia. I salute the noble Lord's tenacity and recognise his concern for individuals who wish to terminate their life at a time of their own choosing. Neither side can claim to have a complete monopoly of the moral high ground. We may disagree strongly about the issues before us, but we are united in wanting the very best for such individuals and for all those who approach the end of their life in pain, distress and fear. I felt the tug of the noble Lord's argument over several months and found the debate helpful in enlarging my understanding through some excellent speeches. The noble Lord, Lord Puttnam, was very moving, and the noble Lord, Lord Carlile, presented a very persuasive argument.

I want to take up one short although complicated issue opened up by the right reverend Prelate the Bishop of Oxford and the noble Lord, Lord Carlile. It is sometimes alleged that people who are opposed to euthanasia as in this kind of debate are religious zealots, with the implication that people without religious convictions—the so-called majority—are not opposed to it. That is a false division. Allow me to focus on just one issue—autonomy—which has been taken up again and again. We all see it as important. You do not need religious convictions to acknowledge that legalising such acts would be a mistake.

It is clear from the Select Committee's excellent report that those who argue for euthanasia use as their main argument the concept of personal autonomy, but, as we have seen, autonomy is a weasel word. Autonomy means making up your own rules, and in a civilised society that is not possible. Who is completely
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free of duties to others, and where do we draw the line where life's decisions are only ours to take? Behaviour in a civilised society is necessarily modified to take account of the interests of others, so principled autonomy should replace the individualistic version of personal autonomy. In the application of the principle of autonomy at the end of life, the choice of the right to die inevitably affects others—especially medical staff who act on your choice and those who are left behind.

It may surprise some to know that Christians support principled autonomy. The Christian emphasis is on duties rather than rights—on personal responsibility rather than personal autonomy. One witness to the Select Committee aptly spoke of,

But it is not only Christians who believe that they cannot expect to have total control over their life. What they can and must have control over is themselves. If we succeed in doing that—how many of us attempt it, and how many of us do it—life will be better for us and those around us. The inevitability of death has to be accepted, but the manner in which I accept it—not whether I can control its time, place and method—determines whether I die well.

I want to intervene in my own argument to speak gently to the noble Viscount, Lord Craigavon, who in his otherwise excellent speech charged the right reverend Prelates the Bishop of St Albans and the Bishop of Oxford with perhaps imposing their view on the rest. If he reads their speeches, he will see that they argue that they want judgment to be made on the rational argument, not on a particular religious point of view. Maybe he is in danger of imposing his view. All of us together have to find a way through the issue.

Christians and those of many other faiths believe that this life is not the sum total of reality and that they are answerable to God for the way in which they live, die and help others who are dying—not by killing them, but by easing their pain and other suffering. They believe that human life is a gift from God and that we have no right to take it. You may say that most people in Britain today are not practising Christians, so why should Christian values be imposed on others? I suggest that there are many—like my parents when I was growing up—who may not go to church or have a clearly defined Christian faith and structure, but the culture from which they draw their values is essentially a Judaeo-Christian one with an emphasis on compassion, forgiveness and the sanctity of human life. Such values transcend narrow denominational boundaries. They know too that the choice to die cannot be regarded as purely personal and private. It affects other people. To ask a doctor to help to draw your life to an end is to draw that person into your choice in a way that cannot be regarded as morally neutral. It will affect the doctor-patient relationship in a fundamental way.

Furthermore, even if people do not share the Christian view that euthanasia is morally wrong, many believe that it is misguided; I judge that from the letters that I have received. In that respect, Christian values
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are at one with good sense and our sense of abiding human values. There are sound secular as well as religious reasons not to go down this road, and I say that with respect to the noble Lord, Lord Joffe. People who argue against changing the law do not do so because they are religious fanatics. Some of them—a substantial number—have religious convictions that tell them that medicalised killing is wrong, but many more can see important civil reasons why society as a whole, especially its more vulnerable members, would be threatened if the law were changed.

8.16 pm

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