Mr. John Denham (Southampton, Itchen) : I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
"the crisis in personal pensions that now threatens the retirement incomes of more than 2 million people".
The problem is very clear and very simple, but the Government have attempted to conceal it behind complacency and inaction.
The problem affects people who have left the state
earnings-related pension scheme, but whose incomes are below about £10,000 a year. Their contribution to their personal pensions is too low : after the pension companies have taken management fees and profits out of their savings, their pensions will be less than they were under SERPS.
The Government slipped out the figures that reveal the position just before Christmas. In January, 147 Labour Members signed a resolution highlighting the problem. Coopers and Lybrand Deloitte estimates that 2.4 million people --40 per cent. of all those who have personal pensions--are now affected in this way. Despite that continuing pressure, the Government have done and said nothing. With every day that passes, the future retirement incomes of nearly 2.5 million people are being unnecessarily and scandalously reduced. The Government have had more than enough opportunities to make a statement or arrange a debate in the House ; I hope that it will now be possible for the House to adjourn, so that we can debate the matter that the Government do not wish us to debate.
Madam Speaker : I have listened carefully to what the hon. Gentleman has said. I must state my decision without giving any reasons. I am afraid that I do not consider the matter that he has raised appropriate for discussion under Standing Order No. 20 and I cannot, therefore, submit his application to the House.
Mr. Michael Fabricant (Mid-Staffordshire) : On a point of order, Madam Speaker. During Scottish Question Time, on Question 10, I endeavoured to come up with a helpful supplementary about using the planned Scottish parliament building in Edinburgh to create extra hotel rooms, as was done in London with the building used by the Greater London council. You cut me off in my prime, and did not allow me to explain the connection with Question 10. It was clear where my question was leading, as will be seen from Hansard tomorrow. I am particularly upset by the fact that, although you ruled the following supplementary out of order as well, you allowed the hon. Member for Glasgow, Hillhead (Mr. Galloway) to continue.
Column 282but perhaps I might advise him--and other hon. Members--to begin with the relevant part in future, rather than keeping me waiting in hope.
Last Monday, I arranged through the office of the Under-Secretary of State for the Home Department to visit Campsfield detention centre near Oxford tomorrow. I saw the Minister last night and thanked him for granting my request. He wished me well and assured me that I would find the detention centre very comfortable.
You, Madam Speaker, will understand my concern and mystification when, a few hours ago, I received a message from the Minister's office that his permission had been withdrawn and my visit was considered inappropriate. That was despite the fact that a senior immigration officer had readily agreed to accompany me and had agreed to my request that I should be allowed to view the centre and to speak to the management and to any detainees who wished to talk to me. You will know that some detainees are on hunger strike and others have been dispersed from Oxford to other prisons and detention centres.
As the Home Secretary has consistently refused to make a statement on this matter, and there is no other way--apart from visiting the centre--that hon. Members can ascertain the true facts, I should be grateful if you could bring any pressure to bear on the Home Office to facilitate such visits by hon. Members.
Mr. Corbyn : Yes, Madam Speaker. You will recall that my hon. Friend the Member for Bradford, West (Mr. Madden) and I have repeatedly raised the issue of Campsfield detention centre and the hunger strike there. You will also recall that I have asked for a debate and for the Minister to receive letters and meet a delegation of hon. Members to discuss what is going on at Campsfield detention centre. You urged me to contact his office, which I have done. I was astounded when, two hours ago, my office received a phone call followed by a fax from the Minister's office saying that he is not even prepared to meet a delegation of hon. Members to discuss what is going on in Campsfield detention centre, including the operation of the hunger strike and the advice given to the private security company--Group 4--which is in charge of the detention centre. The only recourse for individual hon. Members who are deeply concerned about the issue is to raise it with you, Madam Speaker, and ask that the Home Secretary is brought to the House to make a statement, or that, by some means, those of us who wish to do so can give the matter a public airing so that what we believe is a growing scandal in the treatment of asylum seekers is heard, debated and discussed in the House and those poor people who fled oppression can gain some form of justice in Britain.
Mr. Bob Cryer (Bradford, South) : Further to that point of order, Madam Speaker. Can you confirm that if a Minister intimidated, or intended to intimidate, hon. Members in the carrying out of their duty, or in any way
Column 283prevented them from doing so, that could be construed as a breach of privilege ? The actions of Ministers are not excluded from the ordinary remedies available to the House--the High Court of Parliament.
Madam Speaker : The hon. Member has raised a hypothetical point, but the two hon. Members who attempted to raise with me what they call a point of order credit me with more influence than I have. I have no influence whatsoever on Ministers in allowing hon. Members to see various establishments. A point of order should concern a breach of our Standing Orders or procedures. However, there will be opportunities later this week when hon. Members may wish to press those on the Government Front Bench for a debate on this matter, and no doubt they will attempt to do so.
That leave be given to bring in a Bill to prescribe circumstances in which medical treatment and nutrition can be withdrawn and to secure the continued provision in such circumstances of palliative care ; and for connected purposes.
The Bill concerns an extremely sensitive subject, relating as it does to the last great unmentionable--the end which confronts all mankind.
I am sure that the House will join me in congratulating those in another place who recently produced an outstanding report on the complex issue of medical ethics. There is a great deal of good sense in its recommendations, not least in its unanimous rejection of euthanasia, and I hope that it will point the way ahead for many years to come.
I seek to provide the House with an opportunity to reaffirm its opposition to the practice of euthanasia--the intentional killing of a patient by act or omission as part of his or her medical treatment. That practice is, and must remain, illegal. Most of the evidence received by the House of Lords Select Committee on Medical Ethics rejected the practice of euthanasia. The British Medical Association and the Royal College of Nursing, the National Hospice Council and, indeed, other health care organisations all gave evidence to that effect.
The Medical Ethics Select Committee recognised that the medical, legal and social arguments against euthanasia were particularly strong. Medically, it recognised that advances in palliative care had enabled the pain and distress of terminal illness to be relieved in the vast majority of cases. Legally, it recognised that the prohibition of intentional killing is the cornerstone of the law and social relationships and that that protection must not be diminished in any way. Socially, it recognised that, while there may be individual cases where some may consider euthanasia appropriate, the interests of the individual cannot be separated from those of society.
To legalise euthanasia would result in the vulnerable, the elderly, the lonely, the sick or the distressed feeling pressure--whether real or imagined--to request an early death.
In the face of those arguments, there is a minority who think that euthanasia should be legalised. The Voluntary Euthanasia Society continues mischievously to claim that 79 per cent. of people in this country are in favour of euthanasia, basing that claim on an opinion poll that it commissioned. However, an investigation by the Select Committee revealed that it asked the question :
"Would you like medical assistance to a peaceful death ?" Few would respond in the negative to such a loaded question. Recently in a public debate, a leading member of the VES stated that many doctors in the United Kingdom are in favour of euthanasia. In reality, at its last conference, the BMA voted four to one against the legalisation of the practice.
We need to clarify the difficult issues involved in the withdrawal of medical treatment. Decisions about medical treatment and the end of life are more complicated now than they have been in the past. As a result of advances in medical technology, patients live longer and can survive conditions that in the past would have meant a swift end.
Column 285While those advances are welcome, they sometimes make it necessary to consider whether initiating a course of treatment will benefit or be a burden to the patient.
The decision can be made more easily in some cases than in others. Where a patient is competent, the decision may be arrived at through discussion between the patient, the relatives and the health care team. I stress that the autonomy of the patient is crucial and if a patient does not want to persist with an aggressive form of treatment, that decision should be respected and treatment withheld or withdrawn. That is good medical practice. It has long been accepted that a doctor does not have to strive officiously to maintain life. The prolongation of life is not the exclusive aim of medical practice, and as the founder of the present-day hospice movement, Dame Cicely Saunders, put it :
"doctors are committed to giving appropriate care to their patients, not to every treatment that may be technically possible". With regard to incompetent patients, or where a patient is confused or unconscious, decisions about treatment withdrawal can be much more complex, for it is difficult to know what such patients' wishes are in the current situation. Advance directives can be helpful in providing guidance about the treatment of such patients, but we should not forget that not all possible situations can be foreseen. No doctor in this country should ever have to face possible legal action because he or she did not, or could not, follow an advance directive to the letter. Such action has taken place in the United States.
If there is no indication of a patient's wishes, decisions must rest with the health care team and the family of the patient. They have to decide whether the treatment to be given is appropriate. That entails an analysis of whether the benefits of treatment will outweigh the burden of the medical procedures.
The House of Lords Select Committee addressed the issue in relation to the case of my constituent Tony Bland, who was tragically left in a vegetative state following the Hillsborough disaster. The Select Committee rightly stated in paragraph 257 of its report : "it might well have been decided long before application was made to the court that treatment with antibiotics was inappropriate, given that recovery from the inevitable complications of infection could add nothing to his well-being as a person."
In short, it would have been perfectly ethical for Tony Bland to be allowed to die long before he did, had the health care professionals involved in his case been advised differently. I take this opportunity to pay my tribute to Tony Bland's parents and to all those people who cared for him towards the end of his life. The House of Lords Select Committee was divided on one issue : the difficult one of nutrition and hydration. In my view, however, food and water are such vital necessities that their withdrawal from a patient who is not in a terminal state can be intended to have only one outcome--killing that patient. They should only be withdrawn, therefore, from a patient who is approaching death and where their administration would be burdensome. I stress that the report of the Select Committee pointed out that the appropriate handling of a case at an earlier stage would mean that the sort of dilemma that the courts considered last year need never arise.
Thirdly, I endorse the Select Committee's call for the provision of greater resources for palliative care, of the
Column 286type provided by the hospice movement to the terminally ill. With almost 200 centres for palliative care in the United Kingdom and with provision for the dissemination of care in hospitals and in the community, so much has been achieved in recent years. In my constituency, the Sue Ryder Manorlands hospice and Ardenlea, which is run by the Marie Curie Memorial Foundation, are two of many whose dedicated work is so highly regarded by Members of Parliament. Additionally, the Select Committee suggested that research into pain relief and symptom control should be more fully supported. I understand that the Government will soon reply to its report and I hope that there will be a positive response to that and to other valuable suggestions.
The demand for palliative care is such that it should be made more widely available. It need not disturb us if, as a secondary effect of such care, the life of the patient may be shortened. That is the so-called principle of double effect, which was supported and upheld by the Select Committee. If the doctor intends to relieve pain and the treatment given is appropriate to that end, the possible double effect should not be an obstacle to such treatment.
I hope that all those people who are interested in such issues will note and heed the warnings from developments overseas. The British Medical Journal reported last month that the Dutch Attorney-General had ruled that a psychiatrist who helped a physically fit, but depressed 50-year-old woman to commit suicide should not be prosecuted. There is also overwhelming evidence that involuntary euthanasia has become widespread. Such cases show that Holland presents a model of how a slippery slope may become ever steeper. By supporting the Bill, the House will echo the great majority of the medical profession who oppose euthanasia. The House will support them in the difficult decisions that they must often take not to persist with medical treatment that would be of no benefit to their terminally ill patients. It will also give renewed confidence to the hospices and palliative care teams who see euthanasia as a negation, in every way, of the ethos that underpins their commitment and inspires their work. Our message today should be clear and it must be unmistakable : with the right sort of care, life can be lived to the full to the very end.
Mr. Tony Banks (Newham, North-West) : I wish to oppose the ten- minute Bill motion of the hon. Member for Keighley (Mr. Waller). I have great regard for the hon. Gentleman, but the way in which the Bill has been introduced is ill-conceived.
I support the concept of euthanasia, not because I am oblivious to the significance of human life, but because, if the hon. Member for Keighley were successful and got the Bill on the statute book, it would further restrict the right of an individual to choose. Everyone has the right to maximum dignity in life and indeed, in death. Through his Bill, the hon. Gentleman seeks to endorse the main themes of the Select Committee on Medical Ethics in another place, as he said. By opposing euthanasia in its report, that Committee attacked the rights of those people who wish to leave this life with dignity. Seneca wrote :
"If I can choose between a death of torture and one that is simple and easy, why should I not select the latter ? As I choose the ship in which I sail and the house which I inhabit, so will I
Column 287choose the death by which I leave life."
Historians will no doubt recall that Seneca was forced to commit suicide.
Those who support euthanasia stress the voluntary nature of the act. It is not compulsory. Nothing in this life is simple and the same is true in death. I accept that multiple moral considerations are involved ; doctors and close relatives can find themselves facing terrible dilemmas. However, the right of an individual to choose must arch across those difficulties.
The hon. Member for Keighley mentioned the withdrawal of medical treatment. The medical profession makes considerable use of what may be described as passive euthanasia. A doctor can exercise many decisions--such as not resuscitating a patient after a heart attack, not administering antibiotics to treat pneumonia or other infections mentioned by the hon. Gentleman, and not inserting artificial feeding tubes through the nose or direct into the stomach. All are examples of passive euthanasia, and they are extensively discussed by the medical profession--if only because advances in medical science allow doctors to prolong the dying process.
Compassionate doctors are often caught between the suffering of their patients and their duty, as they see it, to prolong life. If a doctor does not treat a life-threatening condition in an already sick patient, the doctor makes the choice on the patient's behalf. I see that as a form of medical paternalism--the idea that doctor always knows best. The British Medical Association clearly states that the power to decide rests with patients. A report in the British Medical Journal in December 1991 deplored the lack of guidelines for non-resuscitation orders in hospitals. Regrettably, in far too many cases the wishes of the patient are never even sought, never mind taken into consideration.
Under British law, competent adults have the right to refuse any or all medical treatment. That right is often invoked by people who want to die with dignity, at a time of their own choosing.
The hon. Member for Keighley spoke of a patient becoming incompetent or unconscious of what is happening, or being unable to communicate clearly. In such a situation, doctors cannot know a patient's wishes. Would they welcome a non-treatment decision or the intrusive and sometimes violent treatment necessary to sustain life ?
The hon. Gentleman touched on, but moved quickly away from, the usefulness of advance directives--or living wills, as they are known. Right hon. and hon. Members will no doubt be delighted to know that it is not my intention to pop my clogs just yet, but my wife and I have signed living wills because we believe them to be important. The individual merely states on the advance directive the sort of life-prolonging treatment that he or she does not want if they suffer in future from an incurable disease causing unbearable suffering. A directive also provides for the event of a brain- damaging accident requiring life support systems to
Column 288maintain a vegetative patient, and the option to have one's life terminated. A directive does not ask a doctor to do anything illegal, such as actively terminate life, but only requests that artificial, aggressive or extraordinary means--all medical terms--are not used to prolong the dying process.
In 1992, the BMA gave full support to advance directives, stating that patients' wishes must not be overridden and that doctors must not impose their own views of beneficial treatment on others. The legal status of an advance directive has never been tested in a British court, although statements made in the Court of Appeal and by Law Lords in the Tony Bland case indicated that an advance directive is binding. The hon. Member for Keighley said that Tony Bland could have been allowed to die earlier if the correct advice had been given, but that was not the situation. Tony Bland's parents were forced to go through the whole process of the law to do, as caring parents, what was in their son's best interests. Despite the obstacles that they met, their noble stand was supported by the majority of the people of this country. If Tony Bland had signed an advance directive, his parents would have been spared all that grief and heartbreak. In the United States of America, Germany, Netherlands, Denmark and some Australian states, living wills are fully recognised. Also, a number of countries recognise durable powers of attorney in health matters--something that this country should recognise.
The hon. Gentleman placed great emphasis on the ability of palliative hospice care in keeping patients free from pain. We all acknowledge that hospices do wonderful work, but it is not true that palliative care removes all pain and distress in all patients. I know that is so because my father died of cancer. I do not see a contradiction between offering palliative hospice care and making voluntary euthanasia an option. They should both be included in the range of options available at the end of life. Apart from the unfortunate minority who cannot be kept comfortable, many people simply do not want the slow way of dying that hospices offer. I have great feeling and warmth for the hon. Member for Keighley, but because I believe that euthanasia is a right--the right to live one's life in dignity and to leave one's life in dignity, I must oppose his motion.
Question put, pursuant to Standing Order No.19 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business), and agreed to.
Bill ordered to be brought in by Mr. Gary Waller, Mrs. Marion Roe, Mr. Gerald Kaufman, Dame Angela Rumbold, Mr. Dennis Canavan, Ms Liz Lynne, Mr. Patrick Nicholls, Mr. Frank Field, Mr. Alex Carlile, Mrs. Ann Winterton, Rev. Martin Smyth and Mr. D. N. Campbell-Savours
Mr. Gary Waller accordingly presented a Bill to prescribe circumstances in which medical treatment and nutrition can be withdrawn and to secure the continued provision in such circumstances of palliative care ; and for connected purposes : And the same was read the First time ; and ordered to be read a Second time upon Friday 6 May, and to be printed. [Bill 79.]
As amended (in the Standing Committee), further considered.
Amendment made : No. 30, in page 8, line 40, leave out from it' to end of line 44 and insert
at the time of its being brought from the strata to the surface or, as the case may be, of its treatment in the strata ; or'.--[ Mr. Eggar. ]
-- Amendments made : No. 45, in page 9, line 37, after acquired' insert --(a)'.
No. 46, in page 9, line 38, at end insert
(b) under section 1 or 2 of the Prescription and Limitation (Scotland) Act 1973 (prescriptive possession on ex facie valid deed).'.
No. 47, in page 10, line 1, after above' insert
, in their application to England and Wales,'.
No. 48, in page 10, line 5, at end insert--
( ) Subsection (3) above, in its application to Scotland, shall not restrict the acquisition, as mentioned in that subsection (a) of any such servitude as adversely affects any coal or coal mine to which this section applies ; or
(b) of any other right so affecting (but not adverse to the title in) such coal or coal mine.'.--[ Mr. Eggar. ]
-- 3.58 pm
(10) The Secretary of State shall direct the Corporation to ensure that no coal mine shall cease production until the Coal Authority is established and able to invite applications for licences for these mines under section 26 of this Act.
(11) The Secretary of State shall not perform the functions of the Coal Authority under subsection (10) above.
(12) Where it is agreed that coal production is no longer possible, the Corporation may carry out its duty under subsection (10) above by operating on a care and maintenance basis only.'.
(aa) section 11(10) to (12).'
Mr. Cook : The purpose of amendment No. 1 is simple : to ensure that there are no more closures before privatisation and that we have a truce in the closure programme, which has already given rise to too many casualties and too many human victims. It asks that there should be no more casualties in the few remaining months for which Ministers of the Crown remain responsible for an industry that is still in the public sector.
As well as being a simple amendment, it is charitable, because it takes Ministers at their word. It accepts the
Column 290lavish promises that have been made that privatisation will be good for the coal industry and that pits will prosper under privatisation. [Interruption.] I see that on this point I carry the Minister with me. If he is so confident that pits will prosper under privatisation, what, then, is his problem in keeping open until that moment at least those that remain ?
That will be a lot easier for him to do than it was at the time of Second Reading, because there are now fewer pits than there were when we discussed the Bill on Second Reading. Twenty-two were open then ; there are now 17. What, therefore, will stop him saying that those 17 pits can remain in operation until privatisation ? I hope that he is not planning another round of closures, which would prevent him from accepting this amendment.
I mention that because I notice that it was reported in the Financial Times last week that another two or three pits will close next month after the review meetings that have been convened to consider the collieries that are open. The report even names the five pits on the short list for closure : Bilsthorpe in Nottingham ; Tower and Point of Ayr in Wales, which would mean that there will be no colliery left operating in Wales ; Prince of Wales and Kiveton in Yorkshire. Those pits are at the heart of the amendment. Their fate will be decided next month at those review meetings. If the amendment is agreed to, those pits will go forward to take their chance after privatisation. If it is voted down, they may well be closed. Those pits demonstrate the extent to which we are now closing pits that are financially viable and make economic sense. Point of Ayr is now producing coal at £1.14 per gigajoule. When the Government carried out the coal review they instructed Boyds to review pits that might be closed, and Boyds set targets in terms of cost per gigajoule for every pit for 1995. The figure currently achieved by Point of Ayr is below the figure that Boyds set it for 1995. Already, over a year in advance, it is below the target figure. Bilsthorpe is below the target figure, too, and Kiveton is not only below it but well below. Kiveton colliery is now producing coal at £1.38 per gigajoule, well below the target of £1.53 by 1995 set by Boyds.
Some of the most efficient pits in Europe, producing the cheapest fuel in Britain, which will give consumers the cheapest electricity, are at risk of closure. In a rational world, it should not be necessary for us to come to the House of Commons to move amendments to keep those pits open--but we are not talking about a rational decision. We can see that by considering the pits that have been closed since Second Reading.
Five pits have closed since the House started proceedings on the Bill in January. One of them, Manton, produces coal at £1 per gigajoule-- cheaper than most imports and cheaper than the coal produced by most pits in this country. When Boyds carried out the review for the coal White Paper it reckoned that Manton was the eighth most profitable pit in Britain, with a potential profit margin of 20 per cent. We have just closed one of the most efficient pits in the coal industry. How can the Minister possibly defend that ?
Mr. Joseph Ashton (Bassetlaw) : My hon. Friend mentioned Manton in my constituency, and everything that he said is true. Is there not also a cloak over the proceedings when people close a pit by saying that it will be amalgamated with another pit, or by two-thirds closing it by cutting three faces down to one, as happened at
Column 291Harworth, in my constituency ? That means that men who go for redundancy get £10,000 less because there is no actual pit closure, although some of the faces have closed. The whole process is filled with deception.
Mr. Cook : My hon. Friend touches on a clear case of deception--a proposal for the merger of pits. Such proposals are transparently proposals for a closure of one of the two merged pits. I suspect that the only reason that British Coal is operating by merger rather than by closure is that with "mergers" it does not need to offer the pit concerned for market testing, for private sector operators to come forward to take it over. That is a device to ensure not only that pits close but that they stay closed.
I was asking how the Minister could defend those actions. The reality, as he knows, is that he cannot defend them. I suspect that he will not even try. I know that he cannot because I have here the minutes of the British Coal privatisation project co-ordination group meeting on 14 February, at which the Minister had four
representatives. The meeting took place the week after Manton was closed, and a Mr. Peter Jones, a merchant banker, was minuted as having repeated concerns :
"that cost projections"
"would re-open debate about the reasons for closure of particular collieries".
In other words, if the cost projections on privatisation were revealed, they would expose the fact that the pits that have been closed were just as cheap as those being kept for privatisation--in the case of Manton, probably even cheaper. I must say that, if a merchant banker cannot make the figures fit his case, they must be pretty robust figures. If Ministers are prepared to close pits when the case is so good that they dare not reveal the figures, it underlines the case for the House to pass the amendment to ensure that Ministers do not close any more.
I am told that those cost projections to which Mr. Jones refers arise from another Boyds' study. Boyds is currently making cost projections of the cost of pits under privatisation. Perhaps the Minister could confirm that ; perhaps he could deny it. He would unwise to seek to deny it, because I have one of those cost projections with me. It is the first cost projection for Longannet and is dated 2 March.
That cost projection of the likely cost of coal in the pits after privatisation goes to the heart of our debate on the Bill. What is fascinating about Boyds' conclusion about the cost projections after privatisation is that it shows that the cost of coal will go up, not down. The Minister need not look so surprised. The paper has been already circulated to the DTI coal privatisation unit. He will have some difficulty denying that that paper exists and some difficulty denying that he does not know what it contains.
The Minister will be aware of the assumptions on which the calculation is based, which are revealing. I see that the paper was addressed to Nicola Kirkup. I do not know whether we have a Nicola Kirkup in the House, but I am sure that she can brief hon. Members on what she has read in that document. The assumptions show that, after privatisation, redundancy payments are expected to tumble to £5,000 per head--about a quarter of the present level under British Coal. That is relevant, because another assumption in the document is that 150 workers at Longannet will be sacked on privatisation of that pit.
Despite those savings and costs, the reduced redundancy payments and the reduced number of staff, the