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12.21 pm

Dr. Brian Iddon (Bolton, South-East): I was brought to the debate by the publication of the BMA guidelines in June 1999. In my opinion, doctors should not have the right--at least, not the sole right--to withdraw food and drink from a patient, especially one who is clearly not dying. As other hon. Members have said, food and drink are basic necessities of life. The BMA made an extremely dangerous decision in publishing the guidelines, which are not supported by a considerable number of its members. In that sphere of medical practice, it is not sufficient for the BMA to give doctors "guidance notes" that are likely to be followed to the letter. Instead, it is important to define the position in law--to state, within reasonable limits, what doctors can and cannot do. That is what the Bill is designed to achieve.

I do not want to over-litigate the health sphere, in which clinical evaluation, evidence-based medicine and considered opinion are paramount to provide the optimum care to patients. I pay tribute to all those staff--doctors, nurses and others--who perform the tremendous task of treating and caring for patients throughout the NHS. That should be said in today's debate. I am here to protect the interests of those who have no voice: the elderly, the weak and especially the extremely infirm. In this country, euthanasia, including involuntary euthanasia, is unlawful. The Bill is designed to define the law so that patients and their relatives will have recourse to the courts where that is necessary.

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Debate is urgently needed in the light of the trend apparent worldwide in the medical profession, signalled in this country by the publication of the BMA guidelines. Given that there are nearly 115,000 doctors practising in this country, it is regrettable that the consultation exercise that preceded the publication of the guidelines resulted in the receipt by the BMA of only slightly more than 2,000 responses. A considerable number of those came from members of the general public and various organisations. That is a small return, on the basis of which the BMA decided to publish extremely important guidelines, which have prompted today's debate.

Many doctors who are members of the BMA have expressed dissatisfaction with the guidelines. The Medical Alliance Opposing the Guidance on Withholding and Withdrawing Food and Fluids, has been set up; it already numbers among its membership 6,000 doctors--three times the number of respondents to the consultation that led to the publication of the guidelines. GP Anthony Cole, a founder member of the alliance, has criticised the guidelines as being tantamount to the introduction of a death ethic into the doctoring profession in this country.

In 1991, The Lancet reported that voluntary euthanasia by administering legal drugs at the patient's request seems to have been carried out in the United Kingdom in 1.8 per cent. of all deaths. In my opinion, the percentage is much greater than almost 2 per cent.

The authenticity of a patient's request is clearly not easy to validate.

Mr. Blunt: Will the hon. Gentleman give way?

Dr. Iddon: No. I want to make progress because I know that other hon. Members want to speak.

Last year, the medical profession displayed mixed reactions to the case of Dr. David Moor, who was acquitted of the murder of a terminally ill 85-year-old patient by an overdose of morphine. Of greater concern is the case of the now sadly deceased nursing-home patient, Mary Omerod, whose GP, Ken Taylor, withdrew nutritional supplements without discussions with the nursing staff, although the patient's family was consulted. Mary lived from June to August without food and drink. She died extremely emaciated, weighing less than four stones. The GP in question was suspended from practice for six months by the General Medical Council.

Since the debate was announced, we have been inundated by information about such cases from across the country, by letter and by telephone from individuals and organisations who are against euthanasia. I have not been referring to isolated cases.

The media are peppered with reports of poor decisions that have been made by doctors, sadly, to the detriment of their patients. Do we have the compassionate health service that we want for our increasingly ageing population? I think not. My hon. Friend the Member for Bradford, West (Mr. Singh) has already referred to the case of Patricia White Bull in the United States, who has recovered to a degree after 16 years in a coma. The question is--it has already been posed--whether she would have lived 16 years in this country under those conditions.

The demographic picture of Britain is changing. The number of people over 65 years of age is predicted to rise by 10 per cent. in the next 10 years. The greatest increase

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in numbers will be those who are over 80. Regrettably, a quarter of those over 85 will develop dementia. We must pre-empt these changes by ensuring that high-quality standards of care are available to these people, and not seize upon involuntary euthanasia as a panacea for the demands of the new century.

It is estimated that about 6,000 deaths per day in the United States are in some way planned or indirectly assisted, probably by the double-effect principle, where strong pain-relieving medications are administered that may simultaneously hasten death.

In a study conducted in New South Wales, it was found that more than a quarter of the doctors who were surveyed said that they had taken steps to hasten the death of their patients. The British people must make up their minds--I hope that we are representing their opinions today--and decide whether they want to proceed along the paths that have been taken by other countries such as Belgium, Holland and Australia.

I have cited cases to demonstrate that the Bill does not anticipate the future. Death hastened by commission or omission is already happening throughout the world. Euthanasia is undoubtedly a sensitive issue. We are discussing not only the lives of people or their deaths, but their values. How much do we value human life? To deny a person the enactment of his values at the precise moment of his death must be one of the most irreconcilable of all wrongs.

In 1998, the BMA initiated a consultation exercise on the issues raised by a number of cases, and most notably by the Bland case. As I have already said, more than 2,000 responses were received as part of the consultation exercise. However, who were the respondents? The BMA has not listed them. I cannot find the names of the organisations or doctors who responded. The views of the 2,000 self-selecting people are not necessarily represented by the BMA, yet its guidelines display a significant move towards involuntary euthanasia by claiming to make distinctions between life-prolonging treatment and basic care. It condones the withdrawal of basic life-stuffs, thus hastening death.

The guidelines that the BMA issued in 1999 reveal that it believes that involuntary euthanasia should be routinely condoned without recourse to the courts. However, in 1998, it stated:

In 1993, it stated:

    "In the BMA's view, liberalising the law on euthanasia would herald a serious and incalculable change in the ethics of medicine."

What has happened to the BMA? It has executed a complete U-turn. It has been followed by the Royal College of Nursing, which expressed one view two years ago, but an entirely contrary view now.

Dr. Tonge: Will the hon. Gentleman give way?

Dr. Iddon: The hon. Lady has almost made speeches through her interventions, but I will allow her to intervene.

Dr. Tonge: I am grateful to the hon. Gentleman, but does he understand the way in which the BMA works?

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He criticises the number of people who responded to questionnaires. I do not wish to apologise for the BMA, but it is a democratic organisation. We send representatives of our branches to the BMA annual council, which approved the guidelines.

Dr. Iddon: I am glad to hear that, but the way in which the BMA has misled hon. Members in the past two days by sending out two letters that contain errors is disturbing.

The legal precedent set in the Bland case determined that the medical profession regarded artificial feeding as a form of medical treatment, not that it should be regarded as such in all cases. We should not fall into the trap, as the BMA apparently has, of extrapolating general principles from a borderline case, such as the Bland case, which was determined in the courts.

One of the most common forms of rebuttal by doctors is stating that patients requested assistance to allow them to die. In one study, 60 per cent. of doctors in this country said that they had been asked by their patients to hasten death. How many doctors complied with that demand? Such a request to hasten death may seem an example of an intensely personal moment for the patient, which is met by a caring and empathic response from the doctor. However, how can the authenticity of the patient's request be measured?

One study showed that mild to moderately depressed patients were more likely to exhibit a decreased desire for life-prolonging therapy than non-depressed patients. It has been observed that patients' wishes are not always consistent over time, and can change as disease advances, sometimes in an unpredictable way. How can we be sure that when a patient says yes today, he means yes?

Before doctors decide to omit or withdraw treatment or food and drink, they should consult not only one other doctor, who should be independent of the medical team on the case, but the nurses in the team and close relatives who are involved with the patient. A case conference is appropriate. Although BMA guidelines propose that procedure, I do not believe that it is carried out in all cases of hastened death. In cases of dispute, there should always be recourse to the courts.

I want to refer to palliative care, which has largely not entered the debate. As my hon. Friend the Member for Bradford, West said, voluntary euthanasia is legal in the Netherlands. There are only 70 palliative care beds in the entire country. Such minimal provision stands amid controversy there, and there are reports that euthanasia law is constantly abused. Euthanasia should not be regarded as an alternative to high-quality palliative care.

Palliative care is not only about the quality of life; it is also about the quality of death. Like others, I pay tribute to the hospice movement, which does a wonderful job, and although some do, I wish that all hospitals provided such high-quality palliative care. Doctors should be given instruction in palliative medicine as part of their core training. As far as I am aware, that is not happening. Such training should definitely include the skill of titrating strong analgesics to the patient's pain and condition. There are many routes by which to administer the wonderful drugs of morphine and diamorphine, but I do not believe that all doctors involved with caring for the terminally ill have the skills to administer those drugs as carefully as many of us think they can. We could have debated how the double-effect principle operates

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throughout the national health service. I have only anecdotal evidence for my opinion--that is all it is--that double effect is convenient for some doctors to over-hasten death. It is hard to collect the statistics, but if hon. Members walk round the hospitals and talk to relatives who have recently been involved with death they will hear the stories from them.

I began by telling the House that I am here because I am adamantly against the BMA guidelines. I want to protect the elderly, the weak and the infirm, who have little or no voice. We must make decisions because of changing demography, and the medical profession needs guidance from us. We must lay down the law rather than allow it to use its own guidance, as it appears to wish to do. The Department of Health should put much more effort into promoting palliative care throughout the NHS.

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