House of Commons Hansard Debates for 19 Apr 1995

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not opposed to the water companies engaging in enterprise activities, but they should provide a service to the core business, not the other way around.

Time is short, so I shall conclude with some ideas about how to secure more effective regulation in the future. We need effective economic regulation of the industry in the areas of price and investment. Those issues must be treated much more democratically than has occurred in the past. The industry must be accountable, and it needs to link more successfully with other agencies.

The benefits system must mirror the real needs of people on low incomes. There must be effective environmental regulation of the industry, and hopefully the forthcoming Bill will make a start in that regard. There must be a much more effective consumer voice, and a separation of that voice from the official Ofwat structure. In bringing the water industry to more democratic accountability, we do not intend to shackle management or to take away from professionals the tasks that they perform best. We are simply saying that, regardless of ownership, the water industry provides a public service, and it must be run in a way that is accountable to the public and in a way that recognises their economic, social and environmental needs.

11.8 am

Mr. Peter L. Pike (Burnley): I congratulate my hon. Friend the Member for Sheffield, Hillsborough (Mrs. Jackson) on pushing for this debate on a subject which she has pursued vigorously and considerably. The role of the regulator in the water industry is probably more important than in any other privatised industry. Water is an absolute monopoly, and we do not have the choices in water supply which we have in electricity, gas and telephones. It is also an essential service, on which we all depend.

The hon. Member for Eltham (Mr. Bottomley) made a point about investment, and we must welcome the way in which he approached the matter. I hope that the Government and the regulator take a similar approach. It is wrong that so much long-term capital expenditure is funded from revenue. When hon. Members met the Water Services Association recently, we heard that 80 per cent of long-term capital investment is made from revenue. That is totally wrong, and I hope that the Minister will change that.

On the subject of water metering, it is surprising that it was not the regulator Mr. Byatt--who says he is neutral on the subject, although everyone knows that he is committed to metering--who issued a warning when the Secretary of State made his announcement earlier this month about relying on rateable values until metering could be introduced in the longer term.

It was the Water Services Association and the Water Companies Association jointly which warned against compulsory metering. They said:

"They hope this doesn't mean the thin end of the wedge towards universal compulsory metering for all domestic customers. We would certainly fight that on behalf of our customers very hard." It should be the regulator who is doing that, not the industry; I wlecome what the companies are doing.

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A survey of Members of Parliament was carried out by Access Opinions on the role of the regulators and executive pay. In response to a question on the regulators of privatised utilities needing "to strike a balance between the interests of shareholders, customers and staff",

90 per cent. of Members thought that customers were the most important. Even among Conservative Members, that figure was 82 per cent, while 98 per cent. of Labour Members said consumers. In response to a question asking whether Members believed that Ofwat was adequately protecting the needs of consumers, 36 per cent. thought Ofwat's response was inadequate, 19 per cent. thought it was very inadequate, and 6 per cent. had no opinion.

When the same question was asked about shareholders, the answers went the opposite way, with 58 per cent. answering that they thought Ofwat dealt with shareholders adequately, and 26 per cent. answering "very adequately".

I wish to refer the north-west customer services committee of Ofwat, which tends to do good job. It has limited resources, and I would like to see those resources increased. Mr. Anthony Goldstone, the committee chairman, refereed to disconnections, and said:

"One disconnection is one too many".

The regulator and the Government must address that matter. I would suggest time that Ministers ought to discuss the matter with the Department of Social Security to try to come to an arrangement.

Mrs. Helen Jackson: My hon. Friend and Front-Bench Members may like to know that members of the all-party group went to see the Minister for Social Security, and we are hopefully making some progress on that matter.

Mr. Pike: I thank my hon. Friend for that comment, and there may be an opportunity for liaison on deductions from income support. I believe that that would help that problem.

11.13 am

Mr. Brian Wilson (Cunninghame, North): I add my congratulations to my hon. Friend the Member for Sheffield, Hillsborough (Mrs. Jackson), not only on securing this debate, but on her outstanding contribution during the past few years in ensuring that proper scrutiny is made of this subject through her activities in the all-party group. The hon. Member for St. Ives (Mr. Harris) spoke of the "enormous consensus" in the House on the issue, but I am sure that he would expect me to take some exception to that. Some historic facts make it impossible for there to be consensus, a major one of which is that Conservative Members voted for privatisation and--by association--for the regime under which so many people are suffering. Opposition Members voted against it, which means that there can be no consensus.

We are in disagreement about what has been done to the industry, and the people we represent are on our side of the argument. We have the overwhelming support of the British people, which Conservative Members chose to ignore. Now--when they are facing the electoral consequences--it is a little late to bleat about the "enormous consensus".

I approach the subject from the regulatory side of the argument, and I also speak with slight trepidation, as a Member representing a Scottish constituency in what has

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clearly so far been an English and Welsh debate. That is because we in Scotland succeeded--where, I suggest, the hon. Member for St. Ives and others may now regret that they failed--in stopping the Scottish water industry being privatised.

Unfortunately, the industry will--for a brief period--be under the control of quangos. The hon. Member for Eltham (Mr. Bottomley) rather eccentrically described members of quangos as "people put there on the basis of merit". That is a new description. The Scottish industry will be in the control of quangos for a short term, until it returns to full local authority control.

Unfortunately, we have not had the same success in England and Wales, and we must now try to improve the regulatory system to make it work--as my hon. Friend the Member for Burnley (Mr. Pike) said--on behalf of the consumers.

My hon. Friend the Member for Hillsborough asked whether the Government or the regulator was responsible for what is going on, but I think that it is two sides of the same coin. The regulators are not mystical people dropped from heaven into their positions, but people appointed by the Government to do the work of the Government and to pursue the policies which are inherent in the privatisation programme. In general, that is what the regulators have done, and that is why we are determined that there must be a complete overhaul of the regulatory system, particularly with regard to accountability.

The regulator has allowed massive price increases for consumers in England and Wales, and he is not acting on their behalf. He is, instead, pursuing the policies and logic of the Government. The electorate make no distinction between the Government and the regulator in this area, and they hold the Government and the Tory party responsible for what has happened to water prices over the past few years.

The true scandal was neatly summarised in a recent article in the Financial Times , which gave a recent history of the water industry. The article said:

"The water companies were sold initially for £6.5 billion, with more than £5 billion of debt written off by the government. Yesterday. their market value was more than £12 billion, and shareholders have received more than £2 billion in dividends since privatisation.

Customers, meanwhile, have faced large increases in their water bills, to pay for improvements in water quality, better sewage treatment and cleaning up beaches and rivers. On average, household bills have risen more than 5 per cent. above the rate of inflation for every year since privatisation."

On the basis of that potted history, there can be no consensus. It is an absolute scandal which is increasingly being hung around the necks of the people who voted for privatisation in the first place. The Times summed it up in these terms:

"While customers squealed, shareholders were laughing."

Mr. Peter Bottomley: Hear, hear.

Mr. Wilson: That may be the epitaph on the grave of the Tory Government, and the hon. Member for Eltham (Mr. Bottomley) says, "Hear, hear."

The article continued:

"By 1993, Northumbrian was making operating profits of £69.7 million on turnover of £239 million. One pound of profit in every four was being doled out to shareholders. The rest was rapidly inflating the value of their company. A similar pattern could be seen elsewhere."

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I can assure that hon. Member for St. Ives that there is no consensus on that, either.

Recently, there was a flurry of activity, with a more stringent pricing regime due to come in on 1 April. North West Water suddenly discovered that it had £180 million to distribute to customers and shareholders over the next five years. Immediately, the loyal Mr. Byatt came to the company's aid, and declared that companies "which share the efficiencies made in their investment programmes will face less demanding price controls in future reviews." That was a quote from the Financial Times .

On that point, Kevin Lapwood of Smith NewCourt declared that Ian Byatt's declaration

"has unshackled the sector . . . Investors and the companies have been worried about how they could get the benefits of better financial performance out to shareholders after the electricity experience. They can now promise substantially better than expected dividend growth with the regulator's approval."

The sinners among Conservative Members who have repented and who claim to be enormously worried, but say that the new pricing regime will see things all right and that Mr. Byatt is doing a tremendously good job, are being a little over-optimistic.

Disconnections are an evil, wicked and totally unnecessary act. To leave people without water in their homes is not something for which any civilised society should be responsible. Scotland is not the wealthiest part of the United Kingdom. People there living in poverty have difficulty meeting their water bills, yet it is legally impossible for anyone's water supply in Scotland to be disconnected. Somehow, the system has managed to survive a century and more. If that can happen in Scotland, it can happen in the rest of the UK. Disconnections should be made illegal.

If any Conservative Member seeking consensus or the Minister can stand up and make a moral case for disconnection, I would be interested to hear it. There is no need for disconnections. There are other means of recovery. The marginal loss sustained by non-recovery is one that the water industry can well bear.

The idea of companies for which Conservative Members are mouthpieces indiscriminately denying water to homes occupied by the elderly, small children or the sick strikes me as completely unacceptable in a civilised society. That does not happen in Scotland, and it should not legally be done in England. Why does not one Conservative Member have the guts to say that disconnections should not be legal in England and Wales?

Metering is only another form of disconnection, because if people do not have money to put in the meter, water companies do not even have to dirty their hands physically disconnecting water supplies. Metering is another assault on the poor, leading to further hardship and misery for people who cannot afford the excessive charges caused by privatisation and the lax regulatory regime, for which every Conservative Member voted. There is no consensus. The whole thing is a scandal and a scam, and one reason that the Tories will be finally judged next month, and then in a general election.

11.22 am

The Parliamentary Under-Secretary of State for the Environment (Sir Paul Beresford): This has been an interesting and broad debate. My difficulty is to answer in seven minutes many of the points that were made.

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I was intrigued by some made by my hon. Friend the Member for Eltham (Mr. Bottomley), and it was also interesting that my hon. Friend the Member for St. Ives (Mr. Harris) joined the hon. Member for Truro (Mr. Taylor) in leaning on South West Water. I am sure the company will note that with some concern.

The most interesting contribution was that of the hon. Member for Cunninghame, North (Mr. Wilson), which re-emphasised Labour's preoccupation with regulation to the point of strangulation--which is what we shall be in for if the electorate ever make the mistake of allowing Labour back in.

Privatisation has succeeded in its main objectives of allowing the water industry access to private finance and to enable a much higher level of investment than was possible--as hon. Members on both sides of the House accept--when the industry was in the public sector and subject to public expenditure restraints. Privatisation has removed the water industry's dependence on the Exchequer, and it has enabled a much increased investment programme of around £3 billion each year since 1989, dramatically to improve drinking water quality and the water environment, as well as allowing the renewal and necessary maintenance of infrastructure.

In England and Wales, in 1993, 99 per cent. of 3.5 million tests met drinking water quality standards, and between 1990 and 1993 there was a net upgrading in quality of nearly 16 per cent. of river length--the proportion of rivers in the highest-quality class increased and the proportion in the lower classes dramatically reduced. The percentage of the population at risk of water shortages, hosepipe bans and low pressure have all been dramatically reduced. Since 1990-91--the first full year of privatisation-- the water industry has invested about £15 billion. The new price limits set by the Director General of Water Services last summer allow for a further £24 billion capital expenditure programme over the next 10 years--£11 billion for quality improvements, £12 billion for maintenance of assets and £1 billion for additional water resources and measures to reduce the risk of flooding from sewers.

Mr. Rhodri Morgan (Cardiff, West): Will the Minister give way?

Sir Paul Beresford: I hope that the hon. Gentleman will not mind if I decline, but I have only five and a half minutes left in which to reply.

That large-scale investment programme is necessary to make good the years of under-investment before privatisation--we heard the dramatic example from my hon. Friend the Member for Eltham of the sewage build-up in one Government office. The industry is now engaged on nothing less than a massive modernisation of the water and sewerage infrastructure, which will ensure that it complies with much higher European and national standards. The same level of investment would have been required had the industry remained in the public sector, but without the availability of private sector finance.

Much has been made of charges. Improvements in water and sewerage services and in the environment are not cost-free--somebody must pay. Charges have had to rise to help pay for investment, but the rate of increase in

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charges is much less than in previous years, and for the next five years will be significantly below the increase originally set at the time of privatisation. In his first periodic review of water price limits last summer, the director general set new, tighter limits to apply to charge increases from 1 April this year and for subsequent years.

The periodic review was the regulator's first opportunity to make a fundamental review of companies' costs and efficiency, and to address issues such as the cost of capital. He decided that companies would now be expected to make a lower rate of return on investment and to reduce their costs through greater efficiency. As a result, he was able to reduce price rises over the next five years from the average of 4 per cent. a year in real terms set in 1989 to an average of 1.5 per cent.

Mrs. Helen Jackson: Will the Minister give way?

Sir Paul Beresford: I have only three and a half minutes left. In the full 10-year period from 1995 to 2005 covered by the director general's review, the average increase in charges is limited to less than 1 per cent. a year. Within those average figures, there are, of course, differential rates of price increase for different companies and for different groups of customers, to reflect the cost of the services provided. The price limit that the regulator sets each company applies to the average increase in tariffs.

Despite claims of a perceived growth in water debt and disconnections, they fell by 12 per cent. in 1992-93, by 33 per cent. in 1993-94 and by a further 7 per cent. in the first six months of the following year. Of the 2 million households identified by the Policy Studies Institute report as experiencing water debt last year, fewer than 0.6 per cent. experienced disconnection.

That can normally only take place after a length procedure, in which the water company has obtained a county court judgment that remains unpaid. The power to disconnect supply for non-payment of charges must remain as a last resort, particularly in respect of people who can pay but will not pay. We are not talking of the individuals who were so dramatically portrayed earlier.

Mr. Wilson: How does the Minister distinguish?

Sir Paul Beresford: It is for the courts to do that.

My right hon. Friend the Secretary of State recently made a policy statement about the basis of charging for water in England and Wales. The Government believe that, in the long term, metering is the best basis for paying for water in many circumstances. It is fair and equitable, in that it relates charges directly to the amount of water used and gives customers some control over their bills.

Payment by amount used encourages customers to use only the water they need which, particularly in dry areas, and it is important in developing patterns of water use that are sustainable in the longer term. With lower consumption, the need for costly capital schemes to develop new water resources may be deferred or avoided. Metering also helps in the detection and control of leakage from the distribution system, so it can play an important role in water conservation. It is with regret that I recognise that I shall have to answer specific questions by writing to individual Members.

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Contrary to the impression that Opposition Members have attempted to give, the privatisation of the water industry and the system of regulation that we have established have been both successful and effective. These developments have enabled a huge programme of capital investment to take place. They have brought improvements in water treatment, sewerage and sewage treatment.

As a result, we are achieving higher standards of drinking water quality, as well as higher standards in the water environment. The regulator has ensured that the rate of increase in charges will be much less than in previous years, while the levels of service provided by the water companies will continue, as over the past few years, dramatically to improve. The companies are becoming more efficient. Some of them are already announcing rebates and reductions in customers' bills. These are all developments to be welcomed and encouraged.

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Euthanasia

11.30 am

Mr. Nicholas Winterton (Macclesfield): I have initiated this timely debate because I fear that two fundamental principles are being undermined, which the House must take the earliest opportunity to reinforce.

First, the House is surely the guardian of the rights of the individual citizen. It is the protector of the vulnerable, of the weak and of those who are unable to speak for themselves. It is here and nowhere else that laws upholding that principle should be decided.

Secondly, since the time of Hippocrates, patients have been able to look to their doctors to uphold the highest ethical standards; to do all within their power to protect the patient's health and well-being and never to take steps either of commission or of omission to harm patients, let alone intentionally to bring about their death. The two basic principles that I have outlined are now under threat. I believe that the primacy of this place is being challenged and that the special relationship between doctor and patient, and the wider contract between individuals and society as a whole, is in desperate jeopardy. The threat to both principles is posed by the co-ordinated thrust being made to bring about the decriminalisation of euthanasia.

It is clear from the attendance in the Chamber that many hon. Members on both sides and in all parties share what I can describe only as my profound concern about recent developments. I have no doubt that many of them will seek to take this opportunity to put on record the reasons for their concern.

I am especially delighted to see in her place the Chairman of the Select Committee on Health, my hon. Friend the Member for Broxbourne (Mrs. Roe). I am also delighted to see that a long-serving member of the House, my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), is in her place. Also present is another long-serving member of the Select Committee and its predecessor Committees, the hon. Member for Belfast, South (Rev. Martin Smyth). The hon. Gentleman has served with me on the Select Committee and its predecessor Committees for many years. I see also in his place a Member who led the Select Committee on Social Services with great distinction, the hon. Member for Birkenhead (Mr. Field). I know that he feels as strongly as I do on this subject.

I shall take the opportunity to explain why I and, I believe, the overwhelming majority of those who have considered these issues carefully, have reached the inescapable conclusion that the decriminalisation of euthanasia is as unnecessary as it is unethical and repugnant.

Mr. Harry Greenway (Ealing, North): Is the thrust of my hon. Friend's argument that euthanasia is, in the end, the killing of people? That is against God's law. I recognise how hard it must be at times for individuals to deal with these matters, but we must all die in God's time, not in man's time. Does my hon. Friend agree?

Mr. Winterton: I entirely agree with my hon. Friend's views. Euthanasia is against God's law and against the law of the United Kingdom. The law says that it is wrong intentionally to kill a person. I fully support my hon. Friend's views.

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The Law Commission recently produced a report on mental incapacity, which dealt with the issues that I have raised. It is being considered by an interdepartmental working party established by the Lord Chancellor. Earlier this month the British Medical Association published a document entitled "Advance Statements about Medical Treatment". In my view, parts of that document do not reflect the views of the majority of doctors. If those parts are taken with the sections of the Law Commission's report which call for legally binding living wills, the door to euthanasia could be opened wide.

Mr. Peter Luff (Worcester): Is my hon. Friend aware that his contention that the majority of doctors may not support the BMA's recent document is borne out by a letter that I received from two doctors at the Worcester Royal Infirmary Trust, who expressed strong reservations about the BMA's recent document? They told me that, at a meeting on 10 April, those reservations were widely shared. The two doctors are concerned about the attempt to introduce euthanasia through the back door without the sanction of Parliament.

Mr. Winterton: I can only say that the views expressed to my hon. Friend by doctors in his constituency reflect the views expressed to me by doctors in my constituency and elsewhere. It is worth mentioning that the working party set up by the BMA, which has produced rules and guidelines, does not, I believe, represent the policy of the BMA as a whole. It is also worth noting that only five of the 16 members of the steering committee or working party are doctors. The steering committee was composed mainly of lawyers and, dare I say it, ethical advisers.

It is time that the House pointed out a few basic and inescapable facts to that small, unrepresentative and essentially unaccountable clique of lawyers and doctors and reminded them that any move towards euthanasia has been made redundant by our world-leading pioneering of the hospice movement, with which I am proud to be involved in my capacity as a vice- president of the East Cheshire hospice in Macclesfield, which my hon. Friend the Member for Congleton (Mrs. Winterton)--I am delighted to note that she has just taken her place--and I jointly opened in the presence of the Lord Bishop of Chester, Michael Baughen. Any move towards euthanasia has also been made redundant by tremendous developments in palliative medicine, and great strides in geriatric services.

Dame Elaine Kellett-Bowman (Lancaster): Does my hon. Friend agree that we should take a lesson from what has happened in Holland? If we take one step down this road, there is no stopping the rush to euthanasia. We must be warned by Holland's example.

Mr. Winterton: The House should note carefully what my hon. Friend has said. She is a long-serving Member. I intend to take up the example of the Netherlands. We must be careful before any decisions are taken to move down the path to any form of euthanasia. I remind those doctors and lawyers and their allies in the Voluntary Euthanasia Society that the prohibition of intentional killing is the very cornerstone of our civilised society and of our law. The role of the doctor is to cure and, if that is not possible, to care for his patients. To permit doctors intentionally to kill would be a dramatic

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change which I believe--I think that my views are widely shared--would discredit the medical profession and undermine the fabric of our society.

No one is saying that the medical profession should strive at all costs, even officiously, to keep alive patients who are dying. Nor is anyone saying that drugs such as painkillers should not be prescribed if one of their side effects is to hasten death, provided that the doctor's motive is pain relief and not the death of the patient. Those are delicate and difficult issues, which the BMA and the Law Commission have failed fully to understand and on which in their reports they have badly let down not only their own professional, medical and legal communities but society as a whole. If euthanasia were to be decriminalised, the elderly, the infirm and the chronically sick would immediately be under both real and perceived pressure to request it to end what is portrayed as the burden that they place on the shoulders of relatives and society as a whole. What starts as voluntary euthanasia would rapidly become encouraged euthanasia, which would then become pressurised euthanasia and then, inevitably, compulsory euthanasia. I will hear no calls in the House today of "death with dignity" or of a "blessed relief from an existence of unbearable pain." Outstanding advances in symptom control and pain relief enable hospice doctors and others to relieve pain in the overwhelming majority of cases.

What the disorientated elderly require is love. How often is that word used in the Chamber? They want compassion. They want understanding. They want support. They do not want death. What the incurable cancer sufferer needs is nursing care, pain relief and, what is more, emotional relief and help with an uncertain but approaching death, and the impact that it will have on loved ones. What the AIDS victim needs is medical care, nursing care, psychological care, and to spend the last of his or her days in the warmth of Christian compassion. What all those groups and many more require is not the indignity of death at the hands of their doctors, but the knowledge that, until the moment of their natural death, they remain valued members of society--loved, cared for and respected for their inherent individual worth.

The heroes and heroines who care for the incurably ill, the psychogeriatric and the severely handicapped in our society today, are legion. We all know that fact as Members of Parliament. They are too numerous to list, but they include all those involved in the hospice movement, those who provide hospice care at home, the Macmillan nurses, the members of the British Geriatric Association, which has been so supportive of what I am seeking to achieve today, and the tens of thousands of doctors and nurses who daily dedicate their lives to care, in their commitment to those who are suffering from terminal or aging illnesses. I put a rhetorical question to the House: does the commitment of those professional caring people count for nothing? Are we to go down the path to mercy killing, as it has come to be known?

It might be helpful if I remind the House that parliamentary concern on these matters led to the establishment in another place of a Select Committee on Medical Ethics to consider the very matters that we are debating today. The appointment of Lord Walton to the chairmanship of that Committee--an individual who was already openly associated with campaigns to promote euthanasia--as well as other members, such as Baroness

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Warnock, who were already publicly on record as supporters of euthanasia, did little to inspire confidence in the Committee's impartiality. Indeed, the majority of its members were believed to be supporters of a liberalising of the law in this area.

Yet, after 12 months of hearing expert evidence, and deliberating carefully on these important issues--the Committee had undertaken one of the most thorough and well-researched reports on euthanasia that this country had ever seen--and despite the preconceived ideas of many of its members, I am pleased to tell the House that its report was unanimous in its rejection of euthanasia. I commend it to hon. Members as essential reading for those who would understand these sensitive and difficult issues.

Something must also be said at this stage about the Voluntary Euthanasia Society and the irresponsible and, dare I say it, devious manner in which it has presented and propagated its views. Naturally, as a Member of the House, I would champion the right of the VES and its supporters to air their views, even though personally I fundamentally disagree with them, but it is worth highlighting the fact that the VES regularly quotes a national opinion poll in which it claims that 79 per cent. of people in this country support voluntary euthanasia. If it is not an unparliamentary word--I hope that it is not--I would reject that claim as twaddle, and observe that the claim was heavily criticised by the House of Lords Select Committee and later by an editorial in The Lancet as thoroughly misleading. The question asked was:

"Would you like medical assistance to a peaceful death?" I am surprised that 100 per cent. of respondents did not say yes to such a loaded question.

If we want to see where the euthanasia road, which the VES, the Law Commission and the BMA would have us follow, is taking us, I would simply point to the tragic situation that has arisen in the Netherlands. There, literally thousands of patients die every year through the deliberate act or omission of their doctors. It is now accepted that many of those patients have neither requested nor condoned the ending of their lives. That is a fact. That is why we must highlight the dangers of treading the path that leads to euthanasia.

To those who say that euthanasia is practised only at the request of patients in the most serious of cases, I would draw to their attention the revelation in a recent edition of the British Medical Journal that euthanasia has been sanctioned in the Netherlands for patients who simply have the misfortune to suffer from depression, and that doctors in the Netherlands are now admitting to euthanasia of new-born handicapped babies, who could not possibly have requested the ending of their own lives. That is the reality of going down the path to euthanasia.

To those who deny the validity of that comparison or who doubt that the authority of the House is being usurped by the campaigners for euthanasia, I repeat the words of John Oliver of the VES in the February edition of GQ magazine, commenting on his views on changes in the law in an article entitled, "Death on Demand":

"I doubt that politicians will have the balls to change it themselves . . . Instead change will probably come in the form of judicial review, with the law being reshaped in the courts--exactly as it was in Holland in fact."

Let me deal now with the issue of advanced directives, or "living wills" as they are sometimes called. It is, and always has been, good medical practice for doctors to

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discuss with their patients the possible outcomes of their condition, the side effects of possible treatments of that condition, and the problems which might be encountered in the future. It is equally good medical practice for the views and opinions of the patient expressed in such discussions to be noted and taken into account by the doctor in the future management of a particular case. To suggest, however, that such opinions should be binding upon the doctor is as much an affront to the doctor's professionalism as it is a denial of proper care to the patient.

It is an approach fraught with desperate dangers. A patient having signed away access to treatments developed at a later date would deny himself or herself, probably unintentionally, the benefits of any progress in medical science. A patient in relatively good health looking forward to a future of uncertainty and eventual dependence on others might be prompted by vanity, pride or concern, among many other understandable emotions, to sign away his or her right to life, without any real knowledge of the emotions that might be felt or would be felt when that stage in the condition was reached. A patient--this could happen so easily--surrounded by greedy or selfish relatives might feel pressured into signing, quite literally, his own death warrant. The cost pressures of the new nursing and residential care arrangements under the community care programme can only exacerbate those very real dangers which face people and their families today.

As Peter Millard, the Eleanor Peel professor of geriatric medicine at St. George's hospital medical school, in a letter to me welcoming this debate, said:

"The major flaw with advance directives is that the concept is based upon single diseases with known outcomes. Whereas medical practice in old age is based on a complex interweave of biological psychological and social factors complicated by multiple pathology. Mismanagement does not necessarily cause death, rather it leads to the bed-bound state. Old people do not want to be a burden and often when sick say they think they would be better off out of it. Advance directives based on oral and written evidence would lead to neglect."

That is what a well-known doctor in geriatric care believes could happen if we trespass down the path to euthanasia and living wills. Is that the situation that the Law Commission and the British Medical Association wish to create?

There are always those, of course, who cite hard cases in support of their arguments. In this debate, the case of Tony Bland, the victim of the Hillsborough disaster, is one such example. It is also a case which many commentators misunderstood by thinking that it was simply a matter of switching off a life support machine. But that was not the case. Tony Bland was not on a life support machine. He was breathing unaided and was certainly not about to die. Furthermore, he never requested euthanasia. The question which the court was asked to decide was whether food and water could be withdrawn from a patient who was neither dying nor in the final stages of a terminal disease. The Law Lords decided, in their wisdom-- wrongly, I believe--that food and water could be so withdrawn without any recourse to Parliament for authority for that ruling. Therefore, Tony Bland was deliberately killed through lack of hydration and nutrition.

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