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Mr. Blunt: The hon. Gentleman says that the BMA guidelines are confused, but I remain confused about the hon. Gentleman's views on the basic issue of whether or not artificial feeding and hydration is treatment. In response to interventions, he implies that it is not treatment and should not be regarded as such, but he then states that it is treatment when describing the circumstances in which one might be regarded as seeking officiously to sustain life. What is his conclusion on whether artificial feeding and hydration can be described as treatment?

Mr. Dobbin: My view is simply that providing food and fluid constitutes care of the patient.

The difference of opinion within the medical profession was made clear in a letter sent to all Members of Parliament by John Finnis, professor of law at Oxford university, John Keown, lecturer in medical law at Cambridge university and Lord McColl of Dulwich, professor of surgery at Guy's hospital. The hon. Member for Congleton has already quoted the letter, but it is worth repeating one sentence:

That provides important clarification. In addition, not all members of the BMA medical ethics committee, which published the guidelines, were in agreement on the final version. To allow the current position to persist leaves a loophole that opens the way to euthanasia. I urge the House to support the Bill.

10.28 am

Dr. Peter Brand (Isle of Wight): I congratulate the hon. Member for Congleton (Mrs. Winterton), not only on coming top of the ballot but on her choice of the subject of her Bill and, indeed, its title. For some weeks prior to its publication, I was in some difficulty as to the reply I should send to the many constituents and organisations that wrote to me about it.

There is no doubt that the practice of medicine is changing, as is the way in which people interact with medical services. The traditional pattern of people knowing their avuncular, paternalistic local GP for 10, 20 or 30 years is fast disappearing. I have been privileged to spend the past 20-odd years practising in the same village, caring for the same population, but that is no longer the norm in much of our country.

If the Prime Minister is to be believed, we shall from now on gain access to the national health service through the telephone lines of NHS Direct or through polyclinics with a duty doctor or nurse. The hospital sector will be far more "industrialised", with people being rushed through. Standards of nursing care remain technically good, but are sometimes lacking in the care aspects because of the sheer pressure of work that hospital workers experience. I understand why the hon. Member for Congleton has picked this important issue. Many people are uncertain as to what the practice is now and what it should be. Clearly it is a matter that should be debated.

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There has been some discussion this morning on what constitutes treatment and what constitutes care. I take the view that that does not matter one little bit. In my view, whatever makes people feel well, even if it does not necessarily make them feel better, is treatment. Having a care assistant sitting beside a bed holding someone's hand when they are confused is treatment. I see little point in pursuing the argument about feeding through a gastrotomy tube or a nasogastric tube, or through a spoon or dribbling cup, because I am not sure whether it makes any difference. The essential difference is the stress that the process causes to patients.

Where I part company with the hon. Member for Congleton is when she draws a parallel between acts of omission and acts of commission. I find that extremely difficult. We have all been bombarded with bits of paper from various organisations, some very reasonable and some entirely extraordinary. I have received a very good leaflet from Right to Life. It is a well-argued set of paragraphs. However, the people who call themselves Right to Life seem to forget that there is a parallel to the right to life, and that is the right to death. We sometimes forget that people are entitled also to slip away and to leave this life in a quiet, peaceful manner. If the Bill had been an Act and part of the law when I qualified as a doctor in 1971, I think that I would now be a multi-murderer. Medical killing is equal to murder. The withdrawing of treatment or not instituting treatment, knowing that that will hasten or even cause death, would be murder.

It is a curious thing--

Mr. Kevin McNamara (Hull, North): The hon. Gentleman is making an important point that needs to be clarified. Is he saying that his purpose in withdrawing treatment was to hasten or otherwise cause the death of a patient? That is the nub of it.

Dr. Brand: That is an extremely good question. I think that the answer is that I allowed death to occur. That is the nub of the argument. To assume that medical intervention can guarantee life or death is nonsense. That assumes that doctors have powers that they do not possess. It assumes powers of prognostication that doctors do not have. I do not know which of the Members now in the Chamber will drop dead tomorrow, next week or during the next 10 years. I cannot tell.

Mr. Nicholas Winterton (Macclesfield): Neither can they.

Dr. Brand: Quite.

I may be faced with an elderly lady who I know has been very unhappy over the past five years, who has been increasingly confused and who is finding life a real burden. If that lady develops bronchopneumonia and I know that she does not want any further treatment because we have talked about the matter, and I withhold antibiotics, I might have made an assumption that if I treated that bronchopneumonia that lady would get better and might carry on for another five years. On the other

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hand, I know that there is a greater likelihood if I withhold the antibiotics that she will die, probably in the next few days, quietly slipping away.

Mr. Winterton: I am following the hon. Gentleman's argument closely. I respect him because he is a qualified doctor.

Dr. Brand: That is no reason to respect me.

Mr. Nicholas Winterton: I think that people instinctively respect the medical profession, and I want that respect to continue. The hon. Gentleman is talking about treatment, but in the example that he has given, would he withdraw food and hydration? I think that that is an important question. Will he answer it?

Dr. Brand: That is a good point. There is a distinct difference between medical interventions in the sense of giving antibiotics, performing operations, putting people on a heart-lung machine, putting up drips and all that sort of paraphernalia, and basic care--for example, keeping people warm, keeping them supported and making sure that, even if they are not conscious, there is someone sitting with them.

When I used to train general practitioners, they were always astonished when I said, "One of the most satisfying things as a general practitioner is to have been involved with a good death." We all become excited about curing people and delivering babies, for example, and that is all splendid. However, there is something intensely satisfying when at the end of the day someone passes away quietly and in dignity while supported by his family. That person feels that he has not upset other people and the people concerned are not upset. The whole process is a happy one. That might seem bizarre.

That sort of death with dignity involves the support of others. There should be good nursing so that people do not have dried, cracked lips. They should have regular mouth washes and lip salves should be applied. They should not be allowed to develop bed sores. That is good basic nursing and care.

I would differ slightly from the hon. Member for Macclesfield (Mr. Winterton) if that good basic nursing and care involves struggling with and half drowning people to get water into them, by placing tubes down their gullets when they do not want that to happen. That is not basic sense.

Mr. Winterton: That is not what the Bill says.

Dr. Brand: With all due respect, to take up that sedentary interjection, the Bill is not clear. The Bill provides that there shall be no omission that will knowingly hasten death.

Dr. Tonge: May I give another example to the House? Let us say that a terminally ill patient dying from cancer has a cardiac arrest and could be resuscitated with cardiac resuscitation. If the doctor decides not to provide that treatment in the best interest of the patient, with the purpose of letting the patient die, is that what the Bill will prevent?

Dr. Brand: I do not know. I am not a lawyer. As I read the Bill, however, it would prevent just such a thing.

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An earlier example was the kidney patient on renal dialysis. That patient can refuse further dialysis and therefore choose to die. If that patient cannot make that declaration and goes into a uraemic coma, and if the renal physician had been aware of his feelings but the patient had not been fit enough to refuse dialysis, should he impose dialysis on the patient, or could he allow him to slip away? According to the opening remarks of the hon. Member for Congleton, I imagine that it would be incumbent on the renal physician to dialyse, otherwise he would be committing murder. I find that extreme. There is a real difficulty because the Bill seems bland and innocent, but some of the arguments around it are fairly extreme.

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