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12.38 pm
Mr. Michael Trend (Windsor): It is a great pleasure to follow the hon. Member for Bolton, South-East (Dr. Iddon) and I have much sympathy with most of what he said. I shall come to the Bland judgment, but perhaps the House needs to look at double effect again and debate how it is developing.
I congratulate my hon. Friend the Member for Congleton (Mrs. Winterton) first and foremost on her good fortune in securing victory in the ballot and on her good sense. She is a well-known campaigner on such issues and has introduced a timely Bill on a matter about which the public are becoming increasingly concerned as a result of the Bland judgment and developments since it was made. I admire the sense of proportion in her Bill. We have had a fascinating debate and understand that this issue has been highly complex throughout human history, but since the Bland judgment, and after various advice and guidelines were provided by the British Medical Association, we have all been conscious of being on new ground. We must stop and ask ourselves whether that is where we want to be.
As many hon. Members have pointed out, we have arrived at this situation partly because of the extraordinary advances in medical science over recent years, which are wholly welcome. We must also note that those difficult decisions used to be made mainly at home with a family doctor who knew the people involved intimately. Now they are increasingly made in institutions, and it should be legitimate for those institutions to test what they are allowed to do much more publicly.
In modern society, there is also an increasing tendency to delegate responsibility for difficult ethical decisions to those whom we suppose to be experts, as happens in the case of human fertilisation and embryology. That, however, can be only a temporary solution in the most difficult instances. From time to time, it is essential for ethical issues to be retrieved from the experts and, indeed, the courts, and decided here in Parliament. It is only through the House of Commons that ordinary people have an absolute right to be heard, and, in this instance, the voices of the people are what matters most. That point was made strongly by the hon. Member for Glasgow, Kelvin (Mr. Galloway). Apart from his attack on capitalism, I agreed with every word that he said. I do not think I have ever agreed with any word in any of his other speeches, so I was happy to be on his side on this occasion.
We all accept that science moves forward, and by and large we are grateful for that; but the fact that science moves forward does not necessarily mean that we must develop new public doctrines. We can and, in certain circumstances should, insist that modern developments in medical practice conform to a basic code rooted in popular understanding and support. My hon. Friend the Member for Congleton seeks to stop doctors intentionally bringing about the death of their patients, and I believe that her view has overwhelming public support.
Specifically, my hon. Friend addresses the question of whether those charged with the medical care of patients can withdraw nutrition or hydration if that would cause death. I accept that her Bill does not require doctors to strive officiously to keep alive patients who are dying; I also accept that doctors can cease medical care if it is no longer in the overall interest of a dying patient. I accept the doctrine of double effect, which means that doctors can administer drugs to control pain even at the cost of shortening a life.
As I have said, my hon. Friend has a sense of proportion. What I believe she cannot accept--I cannot accept it either--is the view that food and drink should be regarded as a medical treatment, the omission of which would kill a patient.
Mr. Gordon Marsden (Blackpool, South):
I am sure that other hon. Members have, like me, received letters from hospice doctors. Does the hon. Gentleman agree with Mr. Richard Lamerton, from the Hospice of the Valleys, who says that withdrawing medical treatment in this way
Dr. Julian Lewis:
Three Liberal Democrats who are doctors are present, and they all seem to be against the Bill. I cannot resist asking my hon. Friend whether he thinks that being Liberal Democrats makes them believe in euthanasia, or that believing in euthanasia makes them Liberal Democrats.
Mr. Trend:
I think that my hon. Friend is being mischievous, although amusingly so.
Dr. Brand:
That was a cheap intervention. I said at the outset that I opposed active euthanasia. Indeed, I voted against a ten-minute Bill on the subject presented by the hon. Member for Bassetlaw (Mr. Ashton).
Mr. Trend:
I do not think that my hon. Friend was questioning the hon. Gentleman's medical qualifications; I think that he was questioning his party allegiance, which many people find curious.
I read the Bland judgment with as much care as I could devote to it. It is a terrible case. When one reads about it, one's heart goes out to the family of the young boy, especially his father--and also to the judges, who had to
make a very complicated and difficult decision. In the end, the Law Lords were persuaded, although for different reasons, that the decision was justified within the current legal framework. As one of Law Lords put it: they were
Initially, I made an intuitive judgment. When I first read of the Bland decision in the press, I felt a cold shiver of apprehension. Whatever the highly complex arguments, my intuitive feeling was that it would lead us into unwelcome territory.
Like all hon. Members, I am sure, I have received a substantial mailbag from my constituents in the run-up to the Bill. For once, I do not detect signs of organised writing. People have written from their own experience, just as we have heard many anecdotes from the experience of hon. Members. My correspondents have precise views on the Bill. All the letters that I have received share the view that it should make progress.
I shall share with the House some of those sentiments--some of the voices that have reached me from Windsor and the surrounding area. In doing so, I hope to make some general points in support of the Bill.
Many of my correspondents are elderly. As one puts it rather well:
It is interesting that many people who wrote belonged to the medical profession. The person whom I quoted is a retired nurse. Another nurse writes:
A retired doctor with 25 years experience as a consultant surgeon and 40 years experience in all in the national health service also refers to the practice of withholding assisted feeding from disabled patients under the pretext that food and fluids are medical treatments. He says:
Another correspondent writes:
I believe that, in the variety of examples that I have outlined, my constituents accurately depict the various deeply held feelings on the issue across the United Kingdom. We have heard much in the press about recent tragic cases in which hospitals have seemed to fail their patients in their last moments, and there may well be a growing feeling among doctors and nurses that in letting a patient slip away, perhaps through a lack of nutrition, they are acting out of a form of mercy. However, I do not believe that that is the view of the vast majority of people in the United Kingdom.
If that form of involuntary euthanasia--or "silent euthanasia", as one of my constituents called it--is allowed to continue, there will be a fundamental shift in the relationship between patient and doctor, and there will be a growing lack of confidence and trust, as evidenced in Holland. That consequence, on its own, is not a price worth paying. In all the complex relationships that exist between human beings, that between an individual and his or her doctor is surely one of the most important and valued, and one that we do not want to see diminished in any way.
I suspect that the core reason for the intense feelings that the subject inspires must be found at a deeper level. People fear that, unless we respect other people's rights to life and a dignified death, we should not be surprised if other people do not respect ours. We should do unto others as we would have them do unto us.
There is a widespread fear that once the principle that people can be killed by withholding food and drink becomes firmly established, it will lead on to a slippery slope--a slide, as we have heard often in the debate. I understood the case made earlier by the hon. Member for Glasgow, Kelvin (Mr. Galloway) that, if one were given the choice between allowing a patient to die from starvation or from the administration of a drug, the second would seem the more humane course. That is a very vivid example of how slippery slopes develop.
" puts doctors in a new world of value judgments which are very dangerous. Those of my colleagues who are happy to dance across this minefield are the very ones I would be most scared of if I found myself in hospital after a stroke and unable to communicate."
Mr. Trend:
There has been a good deal of discussion about that today. The question of which hon. Member present we would like to have as our doctor has arisen frequently.
"forced to take the law as we find it and try to make it work".
They are fascinating judgments. I have enormous respect for them, but I should like the Bill to be passed, so that the courts find a different law.
"As . . . a senior citizen I think you will agree that I have a vested interest."
It is the elderly who are most likely to feel fear at the ways things are going. I suppose that it will come to us all in the end.
"I am a RGN and worked as a Community Nursing Sister for 20 years in full charge of giving nursing care to all in the community. We allowed all people to die with dignity. To die with their boots on so to speak.
She gives an example of a case where someone died of malnutrition and dehydration. It is a harrowing account whose details I would rather not give to the House. She gives a second example of a young girl dying in a hospice with her father next to her. When he asked why the girl had not been fed, the nurse said:
I am horrified at what is happening now."
"why bother when she is dying anyway?"
That will strike a chord with everyone. The father said:
"My daughter is dying of starvation not a brain tumour".
That concern is widespread in the country. It is frequently touched on in the correspondence that we have had. To the majority of people, starvation is simply not an acceptable death.
"This practice leads to a miserable death by dehydration and should not be allowed."
Others have a strong ethical view. They think that it is our ethical responsibility to protect patients from being intentionally killed by their doctors, either by actions that
are taken, or by actions that are omitted, showing that people fully understand the complications of the Bill. Others believe that
"it is a fundamental human right for any person to have sufficient food and water to sustain life until the point of death."
One of my correspondents writes:
"To deny this is a denial of our rights if not an affront to basic human dignity.
We have heard about the experiences in Holland. People are beginning to experience what those people carrying passports for life in Holland are experiencing.
You may be interested to know that some of my elderly neighbours have been afraid to go into hospital."
"There is a tremendous difference between doing all one can to avoid as much pain and suffering at the time of death--and actually killing someone. That decision is not for man to make."
There is a strongly held religious view on the subject, and it is very important that it should be respected.
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