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Mr. Deputy Speaker (Mr. Michael Lord): That is entirely a matter for the Committee of Selection, not for the Chair.

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1.9 pm

Dr. Evan Harris (Oxford, West and Abingdon): I hope that my speech will redress the balance a little, but first I want to compliment the hon. Member for Congleton (Mrs. Winterton). She not only won the ballot, making all of us jealous, but she put her case very clearly and patiently this morning, and has been very willing to consult people about the way in which the Bill is formulated. Even those of us who do not support everything that the Bill proposes recognise the open approach that she adopted, and are grateful for it. I also compliment the hon. Lady on the stamina that she has shown in sitting through the entire debate and listening carefully and attentively to all the contributions.

As it happens, I am a member of the BMA medical ethics committee. I have had a long-standing interest in matters such as these, but I can tell the hon. Member for Bolton, South-East (Dr. Iddon) that I was elected by the profession to that committee, which contains a wide range of people. However, I would like to make it clear that I do not speak for the BMA medical ethics committee. The views that I express are mine, not those of the committee or, indeed, the Liberal Democrat party, as I think that the hon. Member for New Forest, East (Dr. Lewis) tried to impugn in an earlier intervention.

I believe that the Bill is flawed, and that what it sets out to do is wrong. I do not agree with the end that it seeks to achieve. However, in contrast to my hon. Friend the Member for Isle of Wight (Dr. Brand), I think that it may be--just about--amendable in Committee. It is certainly debatable, and it is appropriate that we should look forward to a Committee stage where, in a spirit of constructive debate, we can discuss the issues and see whether the result that the hon. Lady wants can be achieved in a way that does not invite opposition from so many people.

The BMA guidelines are valuable, and a useful addition to the debate. The Under-Secretary of State for Health in the other place said in response to a question by the Baroness Seccombe that they were a welcome addition. The hon. Member for Bolton, South-East made a powerful speech, but it was regrettably hostile to the BMA and the work of its ethics committee. Those guidelines are based on case law. The hon. Gentleman may disagree with the judgments that have formed our case law, but it is right that decisions about end-of-life issues and how doctors behave are there for people to see. In that way, people such as the hon. Gentleman and the hon. Lady can take issue with them. It is better than having everything done in secret on a "doctor knows best" basis. The fact that there are detailed guidelines that have been subject to consultation, that have gone through the BMA's democratic process, and are published on a website should be welcomed.

Dr. Iddon: Does the hon. Gentleman believe that something as important as that should be based on only 2,000 responses--

Mr. Deputy Speaker: Order. This is the second time that this has happened in just a few moments. Members have referred to "this" or "that" without saying what they mean. Visual aids are not encouraged in the Chamber, and for the sake of the Official Report, it would be helpful if the hon. Gentleman says what he is talking about.

Dr. Iddon: My apologies, Mr. Deputy Speaker. Does the hon. Gentleman believe that such an important

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document as the BMA guidelines should have been published on such an important topic, considering that it was based on only 2,000 responses out of 115,000 possible responses and that some of those 2,000 were not members of the British Medical Association?

Dr. Harris: With respect, I do not believe that that is the point. I know that much consulting is done through local medical committees and BMA divisions, which then put a view. There was a very wide debate in the professional medical press about the guidelines, and there continues to be a debate about them at the council of the BMA and its annual representative meeting. They will continue to be debated. I think that any Government would worry if a threshold number of responses to consultations had to be reached before legislation resulting from a White Paper or Green Paper was promulgated.

Mr. Blunt: Does the hon. Gentleman agree that this subject is agonisingly difficult and presents the medical profession, which is at the front line, with hideous decisions to make? Does he also agree that it is rather odd that the hon. Member for Bolton, South-East (Dr. Iddon) should suggest that a three-clause Bill could replace 70 pages of medical guidelines, together with the case law that stands behind it?

Dr. Harris: I agree with the hon. Gentleman. The problem for doctors considering this difficult issue is that there is no statute law, there is only case law. Doctors cannot be expected, I believe, to read the law reports. They should be given a digestible form of advice so that old habits which may be wrong--and, in certain cases, have been wrong--are not simply continued without the due process of audit and check. The Government's quality agenda in the health services, which is backed on the Liberal Democrat Benches and, I believe, throughout the House, seeks to do that. There should be a framework which professionals, not just doctors--and, indeed, not just in the health service--can use to check their actions.

Dr. Julian Lewis: I thank the hon. Gentleman for his courtesy in giving way, but I am not satisfied that he has dealt with the strong points made by the hon. Member for Bolton, South-East (Dr. Iddon). The hon. Gentleman pointed out that the survey was not representative of BMA membership and that, a few years ago, the BMA was making the opposite argument. Why has there been a U-turn?

Dr. Harris: First, there is no U-turn. Secondly, the hon. Gentleman will never be satisfied on some of his points. There was no survey; the guidelines were sent to a large number of members--perhaps all of them--and those who wanted to do so made a response. There is no doubt that the guidelines represent the settled view of the BMA. In any organisation, there will always be a minority who question the general view.

The medical profession is not unanimous in its view on the Bland judgment. It would be astonishing if it were. However, as case law evolves, it is right that the profession should issue its own guidance so that doctors can ensure not only that their actions comply with best practice but--given that the actions of health

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professionals are subject to the law and, indeed, the criminal law--that they do not end up being held to account for their actions in court.

The more that I read the guidelines, the more I support them. They are extremely clear. They do not contain the terrible ideas that have been described. Obviously, we should read the full text, but the guidelines include the following headline points:


Such decisions are taken every day, on every ward, in every hospital. They are set out clearly in the guidelines in the best possible way.

The guidelines continue:


We are debating that issue of quality--especially in relation to the Bland judgment--and whether life should be prolonged at all costs because there is some sanctity attached to it that overrules everything else.

Mr. Andy King (Rugby and Kenilworth): I am grateful to the hon. Gentleman for allowing me to intervene. It is good that a member of the BMA ethics committee is in the Chamber. Will he explain why the committee should adopt shoddy guidance, which does not enhance good practice, but reduces it and does harm to the medical profession? I quote from a letter written by Cardinal Winning. He wrote:


He continued:


    "That this should happen in NHS hospitals"--

Mr. Deputy Speaker: Order. The hon. Gentleman's intervention is long enough. He has made his point.

Mr. Swayne: The cardinal was right about section 28.

Dr. Harris: The cardinal's views on other matters did not cover him in glory. The House should feel strongly about that. [Interruption.] I feel strongly about the matter--as do some Conservative Members in the opposite direction.

There will be subjective views on the guidance. The hon. Member for Rugby and Kenilworth (Mr. King) is within his rights to say that it is shoddy. However, I do not believe that to be true. It would be more helpful to the debate if hon. Members noted--as some have done--that they think that the case law is wrong and that they wanted to overturn that law. I support the case law, but the argument should be about that law, not about guidelines designed to clarify it for professionals working in the

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field. To scapegoat the BMA when one disagrees with case law in Bland and subsequent cases is to choose the wrong target.

I shall now discuss a key point: the issue of artificial nutrition and fluids, which the hon. Member for Hemel Hempstead (Mr. McWalter) discussed cogently. The question whether artificial nutrition and hydration should be considered a medical treatment is not dealt with in the Bill. I believe that the hon. Member for Congleton recognises that whether or not it is within the terms of the Bill, if one of the purposes or the purpose of the doctor in withdrawing artificial food and fluids is to hasten death, such withdrawal should not be permitted by statute law. I repeat that the question whether artificial feeding should be classified as treatment or basic care does not impact on the effect of the Bill. I believe that such feeding is treatment, for reasons that I can give.


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