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Mrs. Ann Winterton: The argument about whether food and fluids are medical treatment goes to the heart of the Bill and of today's debate. In 1991, the BMA--the doctors' trade union, which does not speak for all doctors, as not all doctors are members--defined food and fluids as treatment. That was picked up in the Bland case. Many colleagues, and myself, do not concur with the BMA's definition. We believe that food and fluids are not artificial. They may be given by tube or in another way, but food and fluids are not artificial in themselves; they are basic requirements of life, and should be considered as part of basic nursing care.

Dr. Harris: Clarification is helpful. To my knowledge, no one is arguing that orally given food and fluids are not part of basic care. I have been speaking about artificially given assisted feeding, whether it be tube feeding into the stomach; or a tube, such as a gastrostomy, which comes from the outside into the stomach through the abdominal wall, given through an operation under general anaesthetic; or intravenous feeding, which is covered by antibiotics, has a range of important hygienic and aseptic techniques and must be given by trained medical staff.

The BMA, supported by the judges in the Bland case, recognised that such feeding was treatment, but that is academic when we consider the Bill, because regardless of whether it is treatment or is just considered to be food and fluid, the withdrawal of such feeding would be caught under clause 1. As the hon. Member for Hemel Hempstead said, this is not a narrowly drawn Bill in that sense.

I do not consider that the issues raised in the Bill have anything to do with poor care delivered to elderly patients in geriatric wards in the national health service. The stories that we have read recently are of great concern to everyone. I do not believe that such instances are new, and I know that the Government are anxious to prevent such instances happening. Some of the stories that have been told about ill or dying patients having food and drink removed, or not being offered food and drink, are evidence of inadequate basic care, nursing care and medical attention to those patients; they have nothing to do with the Bland judgment or with the things that the hon. Member for Congleton would probably wish to be outlawed if her Bill became law.

Dr. Tonge: Does my hon. Friend agree that many of the instances that we are all hearing about in our mailbags--complaints against people in the national

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health service for not feeding people who cannot feed themselves--are a consequence of the shortage of medical, nursing and auxiliary staff in the NHS? That is not just due to underfunding of the national health service by successive Governments. Does my hon. Friend agree that it is the responsibility of the British people to call for higher taxes, not tax cuts, in order to get more staff into the NHS?

Dr. Harris: I think that that point is well made. In fairness to the BMA, it has long called--and certainly since I have been a member--for older people to enjoy standards of treatment and care on an equal basis with other adults.

Elderly patients and their relatives have two fears about NHS treatment. The first is that they will not get the treatments and the care that they need because of rationing or discrimination. The other is that treatments that are not effective will be continued beyond the point that is reasonable or compassionate. I have received a number of letters from elderly constituents who are fearful about the Bill being passed in that it might deter doctors and others who care for patients from acting in a compassionate way because they will seek to prolong life at all costs. I understand that that is not the intention of the hon. Member for Congleton and I have attempted to reassure my constituents that even this Bill, with which I disagree, does not seek to do that. However, the hon. Lady must recognise that that fear stalks the land.

When the quality provisions of the Health Act 1999 were considered, an amendment was tabled in Committee and on Report to put a duty on the NHS not to discriminate on the basis of age unless clinically justified. I am sad to say that that amendment, which was tabled by the Liberal Democrats, was not supported by other parties. I urged the Government to recognise that they should at least live up to the commitment that they had made before the last election to conduct an audit to see whether such practices took place. They gave the commitment to Age Concern and other charities that age discrimination would be tackled. It is a pity that a legislative opportunity was lost by the Government and by the Conservative Opposition because they did not support the amendment.

I turn to the Bland case. Hon. Members have described it as a loophole that the BMA and others may seek to expand. That is a subjective view: one man's loophole is another man's safeguard. Those of us who support the ruling in the Bland case recognise that there must be a safeguard for doctors seeking to withdraw treatment--be that life-support treatment or the artificial giving of food and fluids--from patients in such circumstances. Patients must be safeguarded from the prolongation of life when that is no longer in their interest.

The Bill is designed to drive a coach and horses through Bland. It is not helpful for people to misunderstand what that was about.

Dr. Iddon: Does the hon. Gentleman accept that the Bland decision was a judgment and that the Government have said that they do not want that judgment to be enshrined in statutory law? It seems that the BMA almost envisaged the judgment being enshrined in statutory law.

Dr. Harris: That is a matter for the Government. The fact that the Government do not want statutory law to

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apply to such issues is a matter that may concern the promoter of the Bill because of its effect on the likelihood of her ever getting it on to the statute book.

The key point is that, when Tony Bland was 18, he was starved of oxygen after being crushed against the barriers at Hillsborough along with a close school friend of mine, Andrew Devine. I followed the case all the way through when I was at medical school. Tony Bland's family and the local Member of Parliament at the time, who was not a supporter of moves toward euthanasia, made a plea for Tony Bland to be allowed to die peacefully. The court granted doctors the permission to help that to happen. As far as we know, he died peacefully after artificial food and fluids were removed.

We have heard a lot of heightened language about the expression "starving to death". That has been a little glib, even though I understand the intentions behind it. People may die of asphyxia when their brain is starved of oxygen because their heart has stopped; they may die of suffocation when they have respiratory disease--that might not be considered to be pleasant they may bleed to death or, if they have liver failure, they may clot to death. The key question is whether death can be made peaceful, with the patient not in pain. It has to be made clear that, in the event of treatment or artificially given food and fluids being withdrawn, the basic duty remains to ensure that the patient is not distressed or in pain and that symptoms are palliated, so that the patient can die a peaceful death. Talk of the withdrawal of food and fluids inevitably causing distressful deaths is wrong. That is not the aim.

The BMA raised with the hon. Member for Congleton the question whether the Bill would prevent doctors from stopping administering dialysis to a patient who had terminal cancer who did not want further dialysis, but that issue has been dodged by the Bill's supporters. In answer to that case, the hon. Lady said that the purpose in withdrawing dialysis from such a kidney patient who had terminal cancer would not be to hasten death, even though it would hasten death, but would be to carry out the views of the person concerned, expressed when that person was competent. I would question whether that can ever be the purpose in giving medical treatment. Obviously, when giving treatment, one is generally seeking to go along with the patient's views, but it is sophistry to answer that case by saying that withdrawing dialysis, which would hasten death, is not the purpose because the sole purpose is to follow the views of a competent patient.

Mrs. Ann Winterton: The hon. Gentleman has misunderstood my earlier remarks. What he describes is not relevant to the Bill. The Bill does not change either law or practice; all it does is forbid doctors to pursue a purpose of killing a patient by omission. The case he cites is a spurious one that is not relevant to the Bill. The practice if the Bill were passed would be exactly the same as it is now.

Dr. Harris: I accept that the hon. Lady genuinely believes that, but the Bill contains no mention of a competent patient asking for treatment to be withdrawn. She says that no such reference is needed, but if it is not needed, how does she draw a distinction between a competent patient making a decision to have dialysis

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withdrawn and a patient who is no longer competent having said in advance that, if he or she becomes terminally ill, no aggressive treatment such as dialysis or life support should be administered?

The hon. Lady says that there is a difference, as do the supporters of her case. But we are in no doubt as to their views on advance directives. A helpful briefing from Right to Life states:


In her December press statement, the hon. Lady said:


    "The Bill . . . will prevent the development of legally binding advance directives which compel doctors to take action making them complicit in the assisted suicide of mentally incapable patients."

The aim of the Bill's supporters is to detract from the legal status given to advance directives.

What would the hon. Lady do about a patient with a long-standing but progressive cancer of the breast, who may wish to indicate in advance what treatment should be given, withheld or withdrawn should the cancer spread to other organs and the patient become unable to express a view? Would following the patient's informed advance expressed view be open to interpretation as having the purpose of bringing about the patient's death?


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