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Mrs. Winterton: I will make a little more progress and then I will give way.
For all the reasons that I have given, the Bill has one simple focus--to try to restore the integrity of the fundamental principle of the law of murder and to make doctors responsible in law for their purposes in deciding on treatment of their patients. Several organisations have made misinformed comments about the Bill, so it might help the House if I made it clear what the Bill will not do.
First, the Bill will not require doctors to strive officiously to keep alive patients who are dying but, in accordance with good medical practice, they will need to ensure that appropriate care is given to such patients.
Secondly, the Bill will not prevent doctors from ceasing tubal feeding and hydration of patients where, for example, its provision has become too burdensome to the patient or where its continuation would not be of benefit to the health of the patient. However, the Bill will prevent them from ceasing tubal feeding for the purpose of killing patients.
Thirdly, the Bill will not prevent mentally competent adults from taking decisions relating to their own health care--for example, by refusing surgery, by refusing chemotherapy or by refusing blood transfusions.
Fourthly, to reinforce the point made by the hon. Member for Warrington, North (Helen Jones), the Bill will not prevent doctors from providing palliative care or other medical treatment for patients, provided such treatment is appropriate to their condition and necessary to reduce pain and discomfort, even if that has an unwelcome side effect of reducing life expectancy.
Dr. Jenny Tonge (Richmond Park):
I very much appreciate the hon. Lady's reference to doctors not striving officiously to keep alive. In my practice and in all our practice, we have always obeyed "thou shalt not kill", but we have also always obeyed
Mr. Deputy Speaker (Mr. Michael J. Martin):
Order. I remind the hon. Lady that this is an intervention. She may wish to catch the Chair's eye later to put her case.
Mrs. Winterton:
I reassure the hon. Member for Richmond Park (Dr. Tonge) that I am no vitalist who believes that we must deploy the full weight of medical science and technology to prolong life whatever the circumstances. On the contrary, I accept--
Dr. Tonge:
The Bill forces doctors to strive "officiously to keep alive."
Mrs. Winterton:
No, it does not.
I accept that death is the inevitable conclusion of life--indeed, to some of us, its culmination. It is an event for which we should prepare and to which we should move forward with confidence and security, not with fear of our own doctors and their motives.
Ms Julia Drown (South Swindon)
rose--
Dr. Evan Harris (Oxford, West and Abingdon)
rose--
Mrs. Winterton:
I give way to the hon. Member for South Swindon (Ms Drown).
Ms Drown:
The hon. Lady says that she does not want to make treatment too burdensome for patients and that that is allowed for in the Bill, so that a kidney dialysis patient who is deteriorating and says, "I want to die"
Mrs. Winterton:
I could indeed. The hon. Lady is muddling up two completely different things. First and foremost, every mentally competent patient can refuse treatment, as I said. There is no need for the Bill to say that because the Bill does not change the present law in any way. Therefore, a patient can refuse to have treatment. The rather stupid example cited by the BMA does not hold water because someone who is on kidney dialysis and then has cancer that is terminal can refuse to be on dialysis. His doctor would of course explain the consequences of that, but the patient who has made up his mind can refuse treatment. If the doctor tried to give dialysis or any other treatment against the wishes of a mentally competent patient, that would be assault; the present law makes that absolutely clear.
Dr. Peter Brand (Isle of Wight):
Will the hon. Lady give way?
Mrs. Winterton:
No, I will not give way. I have answered the point as clearly and forcefully as I can.
Ms Drown:
Will the hon. Lady give way?
Mrs. Winterton:
I shall give way once more, but then I intend to proceed.
Ms Drown:
I am grateful for that explanation. If, in a similar set of circumstances, a patient wanted to have food or fluid withdrawn, would the same argument apply?
Mrs. Winterton:
If the patient was mentally competent, one would try the purpose test, and if the patient was mentally competent, the law would be as it is now--that a patient can refuse anything. My Bill does not alter that in any way.
Mrs. Winterton:
I intend to make progress, because I realise that many hon. Members on both sides of the argument and both sides of the House wish to contribute.
Last week, I met representatives of the BMA medical ethics committee, including its chairman, Dr. Michael Wilks. Despite my best efforts to allay their fears, Dr. Ian Bogle, chairman of the council of the BMA, has subsequently written to many hon. Members opposing my Bill. However, I must tell the House that their arguments are flawed. Their letter has entirely mistaken the legal effect of the Bill.
Dr. Bogle says that the Bill would "diminish consideration" of the patient's best interests--including values, beliefs, views, and desires about degree and type of medical treatment--and would "make worthless" a patient's valid refusal of treatment
The law has always forbidden doctors to give medicines with a purpose of killing or hastening death. That prohibition in no way diminishes the doctor's duty and right to take into account the patient's best interests, beliefs and so on when deciding whether to give treatment and what treatment to give.
Under the ruling of a majority of the Law Lords in Bland--a ruling unnecessary to the decision in that case--it was equally clear that no one responsible for a patient could withhold or withdraw treatment, care or sustenance with a purpose of killing or hastening death. That prohibition, too, in no way diminished the doctor's duty to take into account the patient's best interests and so on when deciding whether to withhold or withdraw treatment. The Bill would do nothing but restore that legal prohibition.
Dr. Bogle's two scenarios are also entirely erroneous. As I have said, the Bill would certainly not have the legal effect of preventing a doctor from withdrawing dialysis at the request of a patient, nor would a doctor whose purpose in withdrawing treatment for cancer was to follow the patient's informed and expressed view be regarded as having the purpose of bringing about the patient's death. As I said, a doctor whose reason for withholding or withdrawing treatment is to respect the valid wishes indicated by a competent patient, is doing so for that purpose and not for the purpose of killing or hastening death. The same is true of a doctor who decides to withdraw or withhold treatment on the ground that it is medically futile or too burdensome to the patient.
No doctor need fear that the Bill would affect any part of their existing legal and ethical responsibility and opportunity to take full account of the patient's best interests, beliefs, wishes and so on. The Suicide Act 1961 already forbids doctors to assist in suicide. The only doctors who would be affected by the Bill are those who, being responsible for a patient too ill to take his or her own decisions, set out precisely to try to shorten such a patient's life by a course of omissions adopted for that purpose.
Dr. Harris:
Will the hon. Lady give way?
Mrs. Winterton:
I will not; I intend to continue my speech because I have given way so many times already. I hope that the hon. Gentleman will have an opportunity to speak, and, if he catches your eye, Mr. Deputy Speaker, I am sure that he will do so.
Dr. Bogle's claim that the Bill is simplistic and would complicate and hinder the practice of medicine is like saying that the law prohibiting insider dealing is simplistic and hinders investment fund management. Like that law, the Bill would clarify the situation. It would also alleviate well-founded fears of victimisation, free up doctors to use their professional skills to the full and restore a boundary line essential to patients' confidence and trust in their doctors.
The BMA's hasty interpretation of the Bill is completely wrong. My Bill is totally in line with the law and with medical ethics as generally understood and accepted until 1993--and still very widely accepted indeed. It is unlawful and unethical purposefully to hasten death by an act. The Bill would simply return coherence to law and medical ethics by restoring the law's prohibition on the purposeful hastening of death by omission.
Since I announced my Bill in December, I have received a great number of letters and messages of support from a wide variety of sources. Many individuals and doctors have contacted me to tell of their own experiences. I have received messages of support from many leaders of the various Christian denominations, including bishops and archbishops of both the Anglican and the Catholic Churches. In addition, I have received the backing of the Chief Rabbi, Dr. Sacks, as well as of a number of prominent leaders among the Muslim community.
My Bill not only conforms with the European convention on human rights, but positively seeks to entrench its most fundamental right--that of right to life itself. The Bill specifically conforms to article 2 of the convention, which states that
There is a need for the House to send a clear and unequivocal message to the vulnerable, the elderly, the disabled and the terminally ill that they are still valued members of our society. Equally, I believe that it is imperative that we send a message to the doctors and health care workers of this country. That message is that their hard work and dedication to the health of their patients must not be undermined by accepting an ethos, promoted by only a few in their profession, that some lives are less worthy than others and should be brought to an end.
"but needst not strive
The problem with the Bill is that it will cause us officiously to try to keep alive.
officiously to keep alive".
"is to hasten . . . the death of the patient."
Could she clarify that?
"by restricting the law to have regard only for 'the purpose or one of his purposes' of the doctor (Clause 1)".
28 Jan 2000 : Column 694
That is utterly mistaken, as I have just tried to tell the hon. Member for South Swindon. The Bill would in no way diminish the law's requirement and the doctor's responsibility and right to take into account the best interests, values, beliefs, views and desires of patients. The Bill would do nothing except prohibit the doctor from pursuing a purpose of killing or hastening the death of the patient by withdrawing or withholding treatment.
"no one shall be deprived of his life intentionally".
The Bill also promotes the principles adopted by the Parliamentary Assembly of the Council of Europe in its report on the "Protection of Human Rights and the Dignity of the Terminally Ill and the Dying", which states:
"The Assembly . . . recommends that the Committee of Ministers encourage the member states of the Council of Europe to respect and protect the dignity of terminally ill or dying persons in all respects by upholding the prohibition against intentionally taking the life of terminally ill or dying persons".
In giving its support to my Bill, the House would give a clear signal that it supports Hippocratic medicine. It would also continue to send the message that it is opposed to euthanasia either by action or omission. In December 1997, the hon. Member for Bassetlaw (Mr. Ashton) sought to introduce the Doctor Assisted Dying Bill under the ten-minute rule. On that occasion, the House gave its resounding view that such a Bill was not one it wished to see introduced and refused to give leave for the Bill to be introduced, by 234 votes to 89. The House should maintain the course that it set that day by endorsing my private Member's Bill.
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