My Lords, in view of some of the fears that have been expressed I promise not to offer your Lordships the slightest whisper of theology. I speak as a member of the 1994 Select Committee, and as one of those who did not change his mind subsequently. However, I have asked myself how two Select Committees could come to such different conclusions in a matter of a mere 10 or 11 years. I think the answer is that the two committees began from different places. Where you begin frequently determines where you end up. It seems to me that the present report, admirable though it is—I share all that has been said in praise of it and of its chairman—starts from the wrong assumptions and inevitably goes on from there to draw what I believe to be the wrong conclusions.
The 1994 report began with the prohibition of intentional killing, which we saw as the cornerstone of all civil law as well as the basis of trust in the medical profession. Our committee gave much weight to the likely consequences of undermining that prohibition. The new report begins with the concept of personal autonomy, but I believe understands it in a way that fails to give due weight to its potential for being manipulated.
I accept that, on the whole, autonomy is highly desirable and should be respected. But it is important not to forget that the exercise of autonomy is, to a greater or lesser degree, socially conditioned. It takes a very strong-minded person not to be influenced in their perceptions of themselves and of their desires by the way in which other people think about them and by the general social expectations of their culture. In particular, it takes the kind of self-esteem that enables people to struggle against adversity and to want to go on living despite many disadvantages. That self-esteem depends to a considerable extent on the public estimate of their condition. If the general estimate is that they would be better off dead, that is how they themselves are likely to feel.
Let me give an example from a French writer, Emmanuel Hirsch, in a book about accompanying the dying. He wrote:
"In the field of choice between life and death, resort to the notion of individual autonomy is in part an illusion. A patient whose physical and mental faculties are deteriorating may truly want to die, but this desire is not the fruit of his freedom alone. It may be, and more often is, the translation of the attitude of those around him, if not of society as a whole, which no longer believes in the value of his life and signals this to him in all sorts of ways. Here we have a supreme paradox: someone is cast out of the land of the living, and then thinks that he, personally, wants to die".
The truth is that we are not solitary, autonomous units. What we are and what we do are irreducibly social. Let me relate that to what the report in paragraph 102 calls "the paradigm shift", and what I prefer to call "cultural change". Changes in social practice change our perceptions of ourselves and of other people. That is the most dangerous and most widespread aspect of the slippery slope. It is not just that laws are found to have loopholes, or that their application becomes more casual as vigilance decreases, or that individuals find ways of justifying exceptions in their own case. We are familiar with that kind of slippery slope and can in theory devise all sorts of safeguards against it. The central point is that as new practices become familiar, the culture changes, and that has consequences for the way in which people think about themselves. We may imagine that we are making an autonomous choice, when in fact we are merely responding to changed social expectations; as is all too obvious nowadays in the choices made about abortion.
A few years ago, I watched a very moving documentary film about a Dutch doctor preparing one of his patients for euthanasia and then actually performing it on film. It was all very sensitively and tastefully done, and I marvelled at the amount of time, care and emotional energy expended on this one patient. There was a degree of care that it would be hard to match in this country given our present resources. At the end of the film, the doctor was asked whether he found the whole process too emotionally demanding. "Yes", he said, "but it gets easier as you go on". That is precisely the point, because that is the way the world works. That is why I believe that it would be a profound mistake to follow those who have chosen to go down this road.