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Mr. Edward Garnier (Harborough): I thank the Minister for his statement on what is, on any view, a very difficult subject. I shall not take too long in responding to the Minister's statement as I know that a great many of his hon. Friends want to spend much of today discussing the Government's conduct in relation to social security.
I am grateful to the Minister for making a statement in the House about a matter that is currently in the public eye, not least because of the Doctor Assisted Dying Bill, which the hon. Member for Bassetlaw (Mr. Ashton) will shortly seek leave to introduce. I must inform the hon. Member that I shall vote against his motion.
I take this opportunity to thank the House of Lords Select Committee on Medical Ethics and the Law Commission for their invaluable work. We may not always agree with their suggestions and proposals, but they are always considered and cogent, and they deserve more parliamentary time. Indeed, the Law Commission's work receives precious little acknowledgment in the House. I trust that, to some extent, the Minister and I have redressed that.
I welcome the Government's announcement of a Green Paper on the Law Commission's draft Bill on mental incapacity. I hope that the consultation will be wide ranging and thorough, as there is a need for clarity and certainty in this aspect of the law, where little exists.
Is the Minister aware that English law appears to possess no procedures whereby a third party or a court can take a medical decision on behalf of an adult patient without capacity to take that decision? Is he also aware of the concern that public law provides no acceptable power to protect incapacitated or vulnerable people from abuse and neglect? Does he share my concern about clause 11 of the draft Bill, which would, if enacted, give scope to permit medical experiments on incapacitated patients without consent? I heard what he said about the limited nature of the proposal, but will he take on board the concerns that I and many other members of the public have about it?
I welcome the Government's firm stance against euthanasia. Will the Minister examine with the greatest possible care any proposals, from wherever they come, to legalise euthanasia, however clinically described, and to introduce so-called living wills? Disposing of the inconvenient, either by commission or omission, may be the next step.
The Minister spoke of the need for a more informal framework for making day-to-day decisions on behalf of an incapacitated person. Although I understand what he means, we should not lightly ignore the need for formality when the care of the vulnerable is in issue. I accept the Minister's analysis of the current law on incapacity, but he should tread very carefully down the path of rewriting the law without the fullest possible consideration of the legal, moral and ethical issues that are revealed by the Green Paper and the Law Commission report on mental incapacity.
Mr. Hoon:
I am grateful for the hon. and learned Member's support. I agree that, after the Law Commission published its report in 1995, having considered the matter carefully over a long period, it was right that the Government should take the matter forward as urgently as possible. I agree that it is crucial to have wide-ranging consultation. When he examines the Green Paper closely, he will discover that we are consulting on about 107 separate questions. This is a Green Paper of the deepest green, and we are determined to secure widespread support for the proposals.
If I understood the hon. and learned Member correctly, he agrees with me in relation to the present inadequacy of existing law, but I was slightly confused by his comments that appeared to link euthanasia and what I prefer to call advance statements. I carefully distinguished between the two. The Government have no time for euthanasia. As I have said, they remain firmly opposed to any idea that euthanasia might be legalised. However, that is not to say that there may not be a role for advance statements that indicate the approach that people who are at present mentally competent may wish to take if they lose mental capacity. To some extent, such advance statements are already recognised in our law. It is important that we have a comprehensive approach to the matter and that we develop a framework in which these decisions can be taken properly.
Ms Gisela Stuart (Birmingham, Edgbaston):
May I congratulate the Minister on his statement, which is welcome? I congratulate the Government on taking the Law Commission's work forward, but, to prevent any confusion outside the House, will he make it absolutely clear that the proposals have no connection with either euthanasia or so-called doctor-assisted suicide?
Mr. Hoon:
I am grateful to my hon. Friend for her comments. I repeat that the Government are firmly opposed to euthanasia, which is a deliberate action to end life. Anyone with the ability to make a decision is legally entitled to consent to or to refuse medical treatment. An advance statement is a way for a person simply to plan ahead for a time when he may no longer be able
Mr. John Burnett (Torridge and West Devon):
We welcome the Government's open-minded approach to a difficult question. We realise that this part of the law is fraught with conflicts of interest. What is essential is independent advice for donors of extended powers of attorney, and for anyone considering making a so-called living will. Moreover, any witnesses to such documents must have proper independent medical qualifications. I hope that the Government will bear in mind the essential nature of those points before the matter proceeds further.
Mr. Hoon:
I am grateful for the hon. Gentleman's support. I mentioned the importance of seeking to resolve potential conflicts of interest, and the need for greater safeguards, particularly in regard to the securing of independent advice and support for carers who must sometimes make very difficult decisions.
Mr. Tam Dalyell (Linlithgow):
As my hon. Friend is flanked by both Scottish and English Health Ministers, may I ask whether the Government will revisit the possibility of tabling amendments to the Human Tissue Act 1961 to allow a hospital to take the organs of those in whom clinical death has been established by at least two surgeons--neither of whom will be the beneficiary as a renal transplant surgeon--to increase the number of available tissues? That was discussed in detail in a debate that I initiated on Friday 3 March 1979, and has also been discussed in ten-minute Bills. I think that the proposal is well known to Health Ministers, and it would seem to provide an opportunity for legislation.
Mr. Hoon:
As ever, I am grateful to my hon. Friend for his thoughtful contribution. I must tell him, however, that his proposal is well beyond the scope of the Green Paper, and is not the responsibility of my Department.
Mrs. Ann Winterton (Congleton):
The Minister has maintained that the Government are opposed to euthanasia, yet they have not abandoned those sections of the Law Commission's draft Bill that would enshrine deliberate killing by omission. I refer to the withholding of hydration and nutrition. Is not that euthanasia by the back door?
Mr. Hoon:
No. It has nothing to do with euthanasia. Under the present law, medical treatment may be withdrawn if it is judged to be in the patient's best interest not to continue it.
Mrs. Winterton:
What constitutes medical treatment?
Mr. Hoon:
If the hon. Lady will allow me to explain, I will draw an important distinction.
Decisions concerning the withdrawal of artificial feeding from people in a permanent vegetative state must be referred to a court. The Green Paper seeks views on whether decisions on the withdrawal of artificial feeding of patients should always be made by the courts, whether
a person with the new power of attorney to make treatment decisions can decide or whether there should be a "second opinion" procedure.
It is important to recognise that euthanasia is a deliberate act to end life. The intentional termination of life should not be confused with the withdrawal of treatment when it no longer has any beneficial effect, even though that may mean that patients die of their illnesses. Care to keep a patient comfortable should, of course, always be given.
The courts have held that when nutrition and hydration are provided artificially, they are being used to overcome a failure of bodily functions such as the ability to swallow. Just as dialysis to overcome kidney failure is medical treatment, so are artificial nutrition and hydration, which are used to overcome failure of some part of the digestive system.
Mr. Joe Ashton (Bassetlaw):
Is it not an amazing, breathtaking coincidence that the Government have managed to make a 20-minute statement just before my ten-minute Bill? May I reassure my hon. Friend that my Bill is not about euthanasia, and does not advocate euthanasia? I do not think that there was any need to make the statement today.
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