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10.15 am
Mr. Jim Dobbin (Heywood and Middleton): I congratulate the hon. Member for Congleton (Mrs. Winterton) on coming first in the ballot for private Members' Bills. She has told us how she manipulated that, which was very interesting. I also congratulate her on choosing what I know is a very sensitive but important issue for the House and the whole country. The Bill would go a long way to alleviate some of the unease experienced by elderly and vulnerable patients in hospital.
As the hon. Lady said, statute law is becoming confused by recent developments in the courts and there is a need to prevent the principles applied in the Bland case from being extended to patients with other conditions. An increase in the number of patients dying from lack of food and fluid will increase calls for euthanasia. In 1984, Dr. Helga Kuhse, a leading campaigner for euthanasia, said:
Hydration and nutrition are basic human rights and should never be regarded as treatment, and I would like to describe two cases to substantiate my view. An elderly constituent of 92 was admitted to hospital after breaking her femur. She made a fairly good recovery and was transferred to another hospital for physiotherapy and other appropriate rehabilitation.
In the second hospital, the family visitors were requested to avoid meal-times and to visit in the evenings. It soon became apparent to the family that the patient's condition was deteriorating. Her lips were dry, she appeared to be asleep or very lethargic at visiting times, she had developed a bad cough and her colour was poor. The family became alarmed and, when they could not rouse the patient, they asked if she had had anything to eat or drink. They were told that the patient did not want anything to eat and that they could not force feed her. No monitoring of food and fluid intake had taken place.
Fortunately for that lady, her family were determined. They were able and willing to demand that care, treatment and rehabilitation took place and they insisted that their mother be given the treatment, which was the physiotherapy, and the care, which was the food and the fluid, that she needed and deserved.
Several months later, the lady is back home, walking and eating well, and she has made a successful recovery. The family are, of course, happy at the outcome, but dissatisfied with the initial lack of food and fluid and treatment in the second hospital. Therefore, I am pursuing that case with the trust concerned.
Should food and fluid be regarded as treatment or as a basic human right? Without food and fluid, the lady would have died. She is now at home with her family around her, is enjoying life and has regained her mobility.
Dr. Harris:
Does the hon. Gentleman accept that there is no disagreement that normally given food and fluids are basic care and should never be withdrawn? The argument--and there is an argument--is about artificial feeding through intravenous lines or gastrotomy tubes placed during an operation under general anaesthetic and not about the basic food and care that is fundamental to good medical and social care.
Mr. Dobbin:
I accept that, but I suggest that there is now an increasing number of cases where what I describe occurs. There have been several such cases in my constituency.
The second example is that of my own grandson, who was born with an extremely rare congenital neuromuscular disorder, one of the effects of which is that he has great difficulty swallowing. His condition was not diagnosed until more than 10 weeks after his birth; in the intervening period, he lost weight continually. He was tube fed: that feeding was not treatment, but basic care, given to keep him alive until diagnosis could be made. With the help of a drug, taken every three hours for the rest of his life, my grandson can swallow and so eat and drink normally.
Both the cases I have describe prove that food and fluid, however administered, should not be classified as medical treatment. All people, sick and healthy, need food and fluid to live. There have been recent reports of elderly patients being deprived of food and fluid, and I understand that the Crown Prosecution Service is reviewing several such cases. Certain cases in the United Kingdom courts have made the current law unclear, and the Bill would clarify that law.
Dr. Tonge:
Does the hon. Gentleman really believe that the sometimes extremely painful and distressing insertion of a nasal tube leading to the stomach, or an operation for a gastrotomy, which puts food directly into the stomach, do not constitute medical treatment? He has just said that the provision of any food or fluid is not medical treatment.
Mr. Dobbin:
In my view, the feeding process is not treatment, but constitutes care to keep the patient alive.
The BMA recognises the difficulty arising from the blurring of the law and has issued guidelines to doctors. Unfortunately, those guidelines recommend the principle of withholding food and fluid from patients who are likely to live for weeks, months or possibly years if treatment is provided, but who without treatment will or may die sooner. That adds up to a deliberate decision to dehydrate someone who is not dying. The guidelines recommend that the withdrawal of tubal feeding should be allowed for a range of patients, including those who have suffered severe strokes and seriously handicapped newborns, on the agreement of one doctor only; there is no need to apply to the court. Far from clarifying the position, that recommendation confuses it still further.
In the cases I have described--I could have added others--it is obvious that the BMA guidelines could have resulted in wrong decisions being made by medical teams.
Since when have we given doctors and medical staff the duty of deciding whose life is not worth living? We expect doctors to cure us and, if that is not possible, we expect good care and relief of suffering. Hon. Members should ask themselves these questions: if they were taken to hospital and found that they were unable to communicate, would they feel confident that they would be given every care and treatment necessary, or would they worry that their death would be hastened or brought about by dehydration?
The BMA guidelines do nothing to alleviate such fears, which have been experienced by many of my constituents and clearly expressed in many letters that I have received on the subject. The BMA is understandably anxious to protect its members and ensure that no doctor is criticised for decisions about the care of patients. We accept that. However, it is astonishing that the BMA does not support the Bill and that its reasons for not doing so take no account of the clear wording of and intention behind this very simple Bill.
The Bill is not designed with the aim of keeping patients alive at all costs. Nothing in it suggests that treatment, hydration or nutrition should be forced on a patient who is in the process of dying or in cases where the placement of tubes would be regarded as intrusive, inappropriate or engendering excessive risk. The Bill would merely make it an offence to withdraw or withhold medical treatment or food and fluid if the purpose of so doing is to hasten or otherwise cause the death of the patient. Nothing could be clearer.
Mr. Ashton:
Does my hon. Friend accept that the BMA states as a condition for doctors that
Mr. Dobbin:
I accept my hon. Friend's point, but I believe that the BMA guidelines are unclear, both to doctors and to the public.
The Bill would protect vulnerable citizens from becoming the subject of direct killing by making it clear that a doctor cannot act with the purpose of deliberately ending human life. In a letter sent to Members of Parliament, the BMA has put an extraordinary interpretation on the Bill. It cites the example of a patient with long-standing but progressive cancer who may wish to state in advance what treatment should be given, withheld or withdrawn in the event of the cancer spreading and the patient becoming unable to express a view. The BMA claims that to follow the patient's informed and expressed view would be open to interpretation as having the purpose of bringing about the patient's death.
"If we can get people to accept the removal of all treatment and care, especially the removal of food and fluids, they will see what a painful way this is to die and then, in the patient's best interest, they will accept the lethal injection."
The elderly and the disabled are the weakest and most vulnerable in our society and they deserve to be protected. They are not always able to express their views and they need a voice to speak on their behalf. The law, at present, is open to abuse and at times it seems, by withholding or withdrawing food and fluid, euthanasia may already be taking place.
"both legally and ethically, all treatment decisions must promote the patient's 'best interest'"?
If the BMA guidelines are rejected, who is to promote the patient's best interest if the patient is unconscious?
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