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Mrs. Ann Winterton: The Bill describes a purpose against which judgments can quite easily be made. No treatment that is burdensome to a patient needs to be undertaken when that patient is dying. That is established practice now. No tubal feeding need be proceeded with if the doctor's purpose is not to impose treatment that will be burdensome or will not improve the health of the patient. However, the Bill is absolutely clear when the intention behind the withdrawal of food and fluid is for the purpose of ending life. If food and fluid is withdrawn by whatever means, a horrific death occurs. The next step is when relatives are distressed when food and fluid has been withdrawn and say, "Please, doctor, will you give Aunt so-and-so something to put her out of her misery?" If basic hydration and nutrition is withdrawn, the patient is killed. In terms of the Bill, the doctor's purpose is the telling factor.

Dr. Brand: That was a good intervention, but it does not relate to the Bill's contents, which cover "medical treatment", which is a wide term. The Bill does not specify uncomfortable, intrusive or unexceptional treatment.

Another misapprehension relates to the clinician's motivation in making the decision. The people who drafted the Bill believe that doctors are cleverer than they are. I cannot know whether a patient will derive the benefit that I seek from any intervention that I make. I can only know that my action will probably help that patient because it has helped others in similar circumstances. I can say that withdrawing or not prescribing antibiotics for bronchial pneumonia may lead to death. However, I have frequently been proved wrong, and I am pleased that there are higher powers than doctors to deal with those ultimate questions. There is a difference between actively knocking out the bronchial pneumonia sufferer with morphine, thus causing death, and withholding antibiotics.

Mr. Blunt: The hon. Gentleman talks of lack of clarity and confusion. When I asked my hon. Friend the Member for Congleton (Mrs. Winterton) about Lord Browne- Wilkinson's opinion in the Bland case, she agreed with his definition as purpose of treatment to shorten a life. If a doctor withdraws treatment in the knowledge that a likely consequence is shortening a life, that action is defined as purpose, despite the other definitions that my hon. Friend provided. There is a basic confusion about purpose, which makes the Bill as it is currently drafted flawed.

Dr. Brand: The Bill hinges on motivation and purpose. That makes the meaning extraordinarily difficult to tease

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out in a court of law. One can always claim, "I knew there was a likelihood of this person dying, but that was not my primary purpose." That takes us back to the secondary purpose argument.

Mr. Steve Webb (Northavon): I have great respect for my hon. Friend's knowledge, but, to avoid doubt, will he confirm that he speaks from his personal experience, that there is no party line on the issue, and that several of his hon. Friends oppose his views?

Dr. Brand: I intended to mention that as I wound up. I, like other hon. Members, speak as an individual on a private Member's Bill. We are considering an important subject, which is a matter of personal conscience, and we have different views.

Mr. Patrick McLoughlin (West Derbyshire): The hon. Gentleman's experience leads the House to listen to him with care. However, an important purpose of a private Member's Bill is to get an issue raised. The Bill should be considered in Committee, so that some of the hon. Gentleman's points can be fully discussed. There is not sufficient time to do that today.

Dr. Brand: I would have had some sympathy for that point if the Bill had been drafted in a slightly broader way.

Dr. Julian Lewis (New Forest, East): Let it be amended in Committee.

Dr. Brand: The Bill is not amendable because its premise is that acts of omission equal acts of commission. A Bill on euthanasia, which spelt out clearly what could not be done, would have been great. We could then have argued whether omission and commission were the same, and whether basic hydration and food constitute treatment. However, we have missed an opportunity.

Mr. Tony McWalter (Hemel Hempstead): Although the hon. Gentleman's primary purpose in the cases that he has cited from his personal experience was not to hasten death, one of his purposes was to do that, and the Bill claims that if hastening death is a purpose of the person responsible for the care of the patient, he is guilty of murder. Does the hon. Gentleman agree with that analysis?

Dr. Brand: The Bill states clearly that action by the person responsible for the care of the patient is unlawful

The hon. Member for Congleton equates that to murder. I am, therefore, a multiple murderer under the terms of the Bill.

When I had been qualified for a couple of years, I worked as a senior house officer in paediatrics for a year. I looked after a very brave two-year-old kid who had leukaemia. The child suffered many recurrences, which involved a lot of unpleasant treatment, including drips and injections. I could not tell--the consultant could not tell, nobody could tell--whether further treatment would have been successful. However, one Tuesday afternoon, during

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yet another flare-up, the parents said that neither they nor the child could cope with it any more. They asked for all the tubes to be taken away and to be allowed to sit with him. They did, and he died 48 hours later. That was a profound experience. That was not dual effect, for which the arguments of the hon. Member for Congleton allow, but active withdrawal of treatment for a condition that might have responded to treatment. Clearly, I did not withdraw the treatment with the purpose of killing that child, but to prevent further distress to that child and his family. I allowed a death to occur, and that removed distress. The purpose of my action was, therefore, to promote death or at least to enable death to occur. That is an important point.

The hon. Member for Congleton asks us to second-guess God by claiming that we should continue doing whatever we can to keep people alive if they are not guaranteed terminally ill. I cannot guarantee that someone is terminally ill, or how long a patient will live. However, clinicians--and I include the wider team, because nurses have as much, if not more, input, than doctors--relatives and the patient should be allowed to say, "We do not want any further treatment. We want you to stop treatment, even though it may hasten death." Under the Bill, that would become difficult.

I am also worried that the Bill would prevent doctors from initiating treatment because they could get away with not initiating treatment, but not with the decision to switch off and stop treatment. For example, after a stroke, it is right to provide all the high-tech treatment, set up drips, insert tubes and ascertain how people get on. However, if the patient remains vegetative after a week or more, and further progress will not occur, it is clearly humane to be able to withdraw treatment, even though that withdrawal causes death.

Mrs. Claire Curtis-Thomas (Crosby): As the daughter of a mother who existed in a clinically defined permanent vegetative state for more than six months, came out of it and went on to live as a quadriplegic with a very good quality of life for five years, I strongly object to the hon. Gentleman's point that it is appropriate for a doctor to withdraw the treatment that sustains life after a week. That is profoundly morally unacceptable to a significant number of people in this country and has led my hon. Friend the Member for Congleton (Mrs. Winterton) to produce the Bill to curtail that limited understanding of what constitutes life and what should be preserved. The Bill does not advocate--

Mr. Deputy Speaker: Order. I must stop the hon. Lady there.

Dr. Brand: That is an extremely valuable intervention and I look forward to it being expanded in a speech. [Hon. Members: "In Committee."] That is up to the House. May I respond to the very valid question that was raised? There is no doubt that there is a need for clearer guidelines, but they must be guidelines and they must be worked through, and not from the particular narrow point of view that all life needs to be sustained, no matter what is done to sustain it. The right to life should not deny a person the right to death and the fact that someone is not dying does

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not necessarily mean that he is living. [Interruption.] When I sit in the House I sometimes think that I am not dying, but it is not exactly life as we know it.

Mr. Desmond Swayne (New Forest, West): There is a measure of profound agreement with what the hon. Gentleman says among Members on both sides of the argument, certainly with respect to the anecdote he told--I found myself in agreement with him. It is not my perception that the Bill would outlaw what he described; it is a matter of argument. He has referred to the drafting several times and said that the Bill defies amendment. Is that his personal hunch or has he sought advice from the Clerks?

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