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 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?
So I do not think that the Churches, to which I belong, have actually mounted a particularly coherent case against the Bill of the noble Lord, Lord Joffe, but I am willing to give it my support.