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Baroness Noakes: My Lords, we are not much beyond halfway down our speakers' list. Noble Lords might therefore be glad to know that I have left my prepared speech on the Bench behind me. I will briefly make one or two points.
My purpose in putting my name down to speak was to bring motor neurone disease to the attention of the House, a subject on which I have spoken before in your Lordships' House. Motor neurone disease is a horrible disease with final stages that many sufferers fear, and rightly so. It ultimately involves complete paralysis, loss of physical control and pain. The real cruelty, however, is that it involves an unimpaired intellect.
Palliative care for motor neurone disease sufferers, of the quality and in the quantity of which we should be tolerant, is simply not available. I fully support those who say that we should continue to improve the availability of palliative care for all sufferers from terminal illness. Even if we had the most excellent palliative care, however, that would not be sufficient to avoid the need for the Bill. The sufferers of motor neurone disease will lose quality of life and dignity. Not everyone can cope with that. People have different thresholds. Only the individual can make a decision about how great a loss of quality of life they can tolerate.
I support the Bill, with all the safeguards in it. In doing so, I affirm, as a Christian, the sanctity of life. There is another principle, however, which is the right to a good death. The only person who can decide how to balance life and death is that individual, and it is that individual who should answer to God for that decision.
The Lord Bishop of London: My Lords, listening to that speech and so many of the speeches in your Lordships' House this evening, I do not think that anyone could claim a monopoly on compassion on
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either side of the question. I hope that your Lordships are aware that the opposition to these proposals is based on compassion as well. As a priest and former hospital chaplain, like many in this House I have attended a large number of people in their final days and hours. I have often found myself praying with them that their suffering should come to an end.
We have had the case about palliative care rehearsed many times this evening. I do not intend to go into that again. The words of the Chief Rabbi ring in my ears. I remember that he emerged from a debate and said to me, "Very soon, all the main points had been made. But, alas, not everybody had made them". At this stage of the night, a little more brevity is probably required, following the good example of the noble Baroness, Lady Noakes.
It is simply the case that we ought to ask with great urgencypeople on both sides of the argument have agreed with thiswhy the state of the art palliative care available at some of the leading centres like Sheffield, Newcastle and Cardiff is not available to patients dying in other parts of the country. That is surely something on which we can all unite.
It is a pity that members of the committeeI understand the pressures of timewere not able to go together formally to visit a hospice, in addition to the visits to Oregon, Holland and Switzerland that have been generally described. Hospices, in my experience, are places where a lot of living is done in a very short time, in a way that often has a profound and creative effect on those facing death. That is true even for visitors andespecially so, in my experiencefor those who are left behind after a death.
As has been pointed out in this debate again and again, however, there are other forms of distress. I found Professor Blackburn's evidence, which has not yet been mentioned, in response to a question from the noble Lord, Lord Turnberg, particularly telling. It is true, as we all know, that one of the most common things that you hear people say as they face death is that they fear that they are being a burden. Professor Blackburn echoed that in his evidence. He said:
"I am duly afraid of being a burden to other people in various ways. My pride would rebel against it and I would regard the narrative of my life as having gone much worse if it ended in these terrible ways".
People who are dying commonly feel that they are in the way, and it is for precisely that reason that I believe it is helpful that assisted suicide is, at present, not an option. As a life draws to its close, it is hard to be confident about one's motivation and feelings. It may be that a breakthrough to a new reality of human solidarity, to a new depth of experience, of giving and receiving and loving, is part of the education of dying. It is often hard for individuals to foresee that this may be the case. In fact, though, it is the daily experience of those in hospice care.
There are suggestions in the evidence presented to the Select Committeewe have heard much of it this eveningthat the debate is really between people in
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thrall to religious dogma and those who are free to take an objective, human-centred view of the situation. It is, of course, true that the appeal that your Lordships received shows a remarkable identity of views between the followers of the various faith communities and traditions of wisdom represented in these islands. My right reverend brother the Bishop of Southwark signed that appeal; so did the Chief Rabbi, the Roman Catholic Archbishop of Cardiff, the director of the Evangelical Alliance, the head of the Orthodox Church and the high representatives of the Muslim, Sikh, Hindu and Buddhist faiths. In the light of that, we can probably say that the noble Lord, Lord Joffe, could have a great career in interfaith relations ahead of him. I can imagine nothing else that would have brought people together in such a way.
My friend the most reverend Primate the Archbishop of Canterbury, as we have heard, has also written about the question in a similar vein. He has asked me to say that he would have been here, but a long-standing official visit overseas has prevented him from participating in person in this debate.
The concurrence of those different voices is astonishing, but I emphasise that the appeal made to the House is not on the basis of any truth that is inaccessible to all those of good will, whether they are religious believers or not. I find there is great strength at times of distress and confusion in the simple teaching that the Almighty has,
The truth of the matter is that the debate on the proposals is difficult and complex, because there are radically different understandings of the realities of human life. Everyone would agree that it is right to struggle for independence as a person, although some people, like those with mental handicaps, are dependent to a high degree without making their life worthless to themselves or to the social networks of which they are a part. What a human life means is not exclusively the affair of any one individual. Independence or autonomy is an important stage on the way to recognising the interdependence in which we come to see profoundly that "I need you in order to be fully myself". As the noble Lord, Lord Maginnis, said, we were not born autonomous:
We have a right to expect that society will offer care to the dying, but it would be a tragedy if granting new possibilities to a few people contributed to eroding society's recognition of the worth of human life, even when it is subjected to profound disability or impairment. It would be a tragedy indeed if changing the law increased the pressure on many people who recognise their vulnerability to consider suicide.
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Lord Plant of Highfield: My Lords, I support the noble Lord, Lord Joffe, in his endeavours on the Bill and I shall certainly support it in its amended form. I speak as a Christian, indeed, as an Anglican, but what I am going to say will put me very much at odds with my friends on the ecclesiastical Benches, whose views I respect but, unfortunately, disagree with.
I shall start with the view of the value of life. I am not at all sure that Christians have a coherent account of this value. We are told that life is God-given and therefore sacred and of absolute or infinite value. Part of what this presumably means is to imply that the value of life cannot be subordinated to any other value, such as autonomy. However, if the value of life means that it is not subordinate to any other value, one has to ask whether there is a consistent Christian position here. Since the Christian tradition operates with a just war doctrine, it must be the case that human life can be subordinated to other values; namely, those accepted as making a war just. Yesterday, I heard a canon of Westminster on the radio talking at the tomb of the unknown warrior. He said that there are causes worth dying for and, let us not be squeamish, in war worth killing for. I agree with that. But then the supposedly absolute value of life is being subordinated to other values; namely, those pursued in a just war. Some Christians support capital punishment where, again, the value of life is subordinated to some other value.
It might then be argued that what is wrong with assisted dying is that it subordinates the value of life to an inadequate or even false value; namely, that of individual autonomy. We heard this argument put quite a bit today. It was put on the radio this morning by the Chief Rabbi. Sir Jonathan Sacks argued that there are choices that we should not be allowed to make and that we cannot be allowed autonomously to choose our death under the circumstances set out in the Bill. The problem with this point of view is that it is perfectly legal to refuse life-saving or life-prolonging treatment. A close friend of mine did so just a few weeks ago. He wanted to die after 10 years of living with cancer and refused treatment, which could have saved his life, for a minor infection and he died.
So if there are choices, such as the time and circumstances of our own death, that we should not be allowed to make, are those who are critical of autonomy then arguing in favour of compulsory treatment to keep people alive, even when after due deliberation they believe that they would be better off dead? I am sure that members of the Churches do not believe this. If they do not, then it seems acceptable autonomously to choose to die when this requires acts of omission from those tending you, but not when it involves help. This means that the argument about assisted dying does not turn on autonomy at all because this means that what is wrong with autonomously seeking death is not the argument about autonomy but an argument about the categorical moral difference alleged to hold between acts and omissions so that death as a result of non-treatment is autonomous and acceptable, but death as a result of positive help is not. However, this
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completely changes the ground to that of acts and omissions and we are no longer really talking about autonomy at all.
So is there a categorical distinction between acts and omissions? I do not think so. If the aim of an act is to render someone dead, and the aim of an omission or series of omissions deliberately undertaken, such as has certainly happened in policies to do with the selective non-treatment of neonates with significant genetic disabilities, is also to render somebody dead, then the alleged moral difference is a consoling illusion and not a categorical moral difference. I realise how consoling the illusion is, but it is not clear that we are not as responsible for the consequences of our omissions as we are for our actions.
The same applies to the doctrine of double effect, which I also regard as a form of consolation. This doctrine, in the context of dying, states that I may inject a narcotic with the primary intention of relieving pain, even if a foreseeable, although not the intended, effect is the death of the patient before it would otherwise occur. In general, the doctrine of double effect has very perverse moral consequences because in any circumstances in which it is invoked it enables us to evade the moral responsibility for the consequences of our actions by narrowing down the sphere of intention and disavowing our responsibility for foreseeable effects.
I can perfectly see why people are attracted to it, whether it is the statesman in war arguing that the foreseeable effect of the deaths of innocents is not part of his responsibility, or in the very different circumstances of doctors treating patients in traumatic circumstances. This does not alter my view, however, that the doctrine of double effect is not capable of coherent formulation.
Of course, it can be argued that the doctrine of double effect in any case does not apply to the doctor injecting the narcotic since the effects are in fact far from foreseeable and highly individualised, so responsibility does not apply to foreseeable consequences because they do not exist. That argument is very difficult to accept simply because of the popularity of the double effect argument, particularly among doctors who write about assisted dying and reject it. If the effects of narcotics are indeed radically unforeseeable then why invoke the doctrine of double effect, because that only works on the assumption that they are foreseeable?
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