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Mr. Quentin Davies (Grantham and Stamford): I congratulate my hon. Friend on introducing such an important measure this morning. Does she share my concern at growing anecdotal evidence that in the national health service people are being denied certain types of operation or other intervention simply on the grounds of age, and that de facto age discrimination is creeping into the NHS? Will she confirm that her Bill will outlaw that particularly pernicious form of age discrimination?
Mrs. Winterton: My Bill will not target specifically the matters that my hon. Friend raises. But I think that people on both sides of the House believe strongly that elderly people and those with disabilities should have the same opportunity for treatment as able-bodied and younger people. Such a state of affairs would receive universal approval. There is no doubt that there are growing stresses in the national health service. However, I do not believe, and I doubt whether anyone in the
Chamber does, that those who are less fortunate than ourselves should not receive the very best medical and nursing care.
Speaking about the recent cases highlighted by the media, one eminent physician, Dr. Adrian Treloar, said:
It is against this background that I bring before the House for its consideration the Medical Treatment (Prevention of Euthanasia) Bill. It has been drafted in consultation with John Finnis, Professor of Law at Oxford university and Dr. John Keown, lecturer in medical law at Cambridge university, who are among the country's most eminent experts in law and medical ethics. Many other eminent doctors have also been consulted.
The Bill is short, clear and focused--something that, while difficult to draft, is essential to a private Member's Bill.
Sir Paul Beresford (Mole Valley):
I congratulate my hon. Friend on having produced an extremely simple Bill. I have an interest to declare--I am on the Board of Dental Protection, which is part of the Medical Protection Society Ltd, a large mutual society for doctors and professionals in the medical field. The society advises and assists doctors and medical professionals on legal matters. It has deep concerns as to the simplicity of the Bill and foresees the potential of double jeopardy for doctors. Will my hon. Friend meet representatives from the Medical Protection Society to discuss the introduction of some amendments that would allay their fears and concerns?
Mrs. Winterton:
I am grateful for that intervention. As I continue my speech, I may be able to reassure my hon. Friend as to the Bill's provisions, and he will see why the measure is so simple, and why it is good to lay down a basic principle.
I realise that no Bill is perfect and that there are concerns about mine. I should be delighted to meet my hon. Friend's colleagues on the medical and dental organisations to which he referred to discuss their anxieties. I am sure that many such matters will be discussed in Committee. I hope that I have been able to reassure my hon. Friend.
The two experts and the other advisers who helped me to draft the Bill urged that it should pursue one simple objective: to restore the integrity of the fundamental principle of the law of murder. That is exactly what it does. The Bill concentrates on the purpose of the doctor in withdrawing or withholding medical treatment, or food and fluid, however delivered.
If the doctor's purpose is to end or shorten the life of the patient, then the withdrawal or withholding is unlawful homicide. That wording, specifically drafted by Professor Finnis and Dr. Keown, leaves undisturbed decisions to withdraw or withhold medical treatment, or food and fluid, where those decisions are made without purpose of causing the death of the patient, but rather because the treatment would not be of benefit to his or her health, or would be too burdensome for the patient.
Mr. Joe Ashton (Bassetlaw):
The hon. Lady refers to murder. There appears to be no penalty in the Bill--for
Mrs. Winterton:
The hon. Gentleman makes two points. The first is that there is no provision for sentence in the Bill. There does not have to be such a provision, because the measure merely plugs a loophole in the law that has existed since the early 1990s. No change is needed to the rest of that law.
The second point is that in America, where there is a different legal system, there have been no successful prosecutions. That is why the word "purpose" is used. That word is widespread in common law and is easily understood by professionals and by the general public. The hon. Gentleman makes a forceful point, but it would not apply to my Bill.
Mr. Crispin Blunt (Reigate):
As my hon. Friend points out, the word "purpose" is of key importance. Does she agree with Lord Brown-Wilkinson, whose judgment in the Bland case is central to the matter? He stated that the whole purpose of stopping artificial feeding was to bring about the death of Anthony Bland. If my hon. Friend's Bill had been law at that time, that would have been a case of murder, because the purpose was to bring Anthony Bland's life to an end.
Mrs. Winterton:
That is an interesting observation. I should have thought that it was obvious to anyone in the House that, if it is the purpose of the doctor, in withdrawing medical treatment and food and fluids, no matter how delivered, to end the life of the patient, that is euthanasia. I suggest to my hon. Friend that the case he cites describes that situation.
Mr. Peter Bottomley (Worthing, West):
My hon. Friend has been most helpful to hon. Members and to those outside the Chamber by setting out plainly the general circumstances and the purpose of her Bill. She knows that she will receive my support on Second Reading. I think that she also knows that I do not want to reverse the Bland judgment, so she may find that, today, she has support from Members who differ from her over one part of the measure. I hope that she will take account of that point, as it may affect some of the debate on Third Reading.
Mrs. Winterton:
I have heard my hon. Friend's comments; he has expressed that view to me privately. I understand where he is coming from.
The Bill deals with omissions--
Mr. Ashton:
Will the hon. Lady give way?
Mrs. Winterton:
I have already given way to the hon. Gentleman and answered the two points that he made. I shall make a little more progress before giving way again.
The Bill deals with omissions rather than positive actions, because the latter are already murder under existing law. There is no doubt about that. However,
the Bill leaves undisturbed the double effect principle, when a doctor adopts a course of treatment to ease a patient's pain or discomfort, but which may shorten the patient's life. The purpose of treatment in such a case is not to shorten the patient's life; it is to ease pain or discomfort.
The measure will bring to an end the efforts of the euthanasia lobby and of the BMA to widen the loophole created by the Bland judgment, which allowed doctors deliberately to end patients' lives, because those lives were thought to be of no value, rather than because the treatment was of no value. To tackle in one go all the issues relating to advance directives, or "living wills", is too great a task for a private Member's Bill. That is why the Bill does not do so.
Currently, there is much debate about the extent to which advance directives are legally binding. The Bill will not affect their legal status in any way, but a substantial vote in its favour will slow down the development of legally binding advance directives by sending a clear message that Parliament does not want the law to go further in that regard. The House would thus endorse the Government's decision not to proceed further with the development of advance directives.
Helen Jones (Warrington, North):
I am grateful to the hon. Lady for giving way. She knows that I have much sympathy with what she is trying to do. I am anxious about the problem of double effect. As the measure is drafted so as to rely on the doctor's purpose, that poses an evidential problem. It could put at risk doctors who have given a patient treatment which they know will both relieve suffering and hasten death. Will she expand on that point? As she will appreciate, it is difficult to prove purpose in a court.
Mrs. Winterton:
I am grateful to the hon. Lady for making that point. I assure her that the Bill will not affect double effect, which is accepted medical practice at present. The best lawyers have assured me as to that. The measure will allow doctors to continue their present practice, as long as their purpose is to relieve pain and suffering. That would be obvious when a person is terminally ill; indeed, many of us have had experience of such cases. The measure would not prevent the doctor from giving the best possible treatment to his patient, even though the effect might be to shorten the patient's life. That is because the measure takes the common law definition of purpose, which is understood by everyone. The Bill will not change that in any way.
"If the medical profession is going to move, as they have done, to a position where they accept the deliberate withdrawal of food and fluid from patients, then it's very difficult for patients to trust the doctors."
That is a very valid point.
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