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Mr. Blunt: On a point of order, Mr. Deputy Speaker. I anticipate that, in a few moments, a closure motion will

28 Jan 2000 : Column 748

be moved. When you come to consider it, will you bear in mind that neither the chairman nor the two vice-chairmen of the all-party parliamentary doctor assisted dying Bill group were fortunate enough to catch your eye?

Mr. Deputy Speaker: Order. That is not a matter to be raised now.

Yvette Cooper: In current case law, only when an intervention or medical treatment is in the best interests of the patient, taking all relevant factors into account, is it lawful to start it. Similarly, only if an on-going intervention is in the best interests of the patient is it lawful to continue it. If the treatment is not in the best interests of the patient, it is not lawful to give it; hence, the doctor can have no duty to give it.

The lack of reference in the Bill to consideration of the patient's interests means that there is a risk that doctors, to ensure that there could be no doubt about any of their purposes, may feel pressurised to provide treatment beyond the point at which it is in the patient's best interests.

The hon. Member for Congleton and others have made it clear that they do not want to stop doctors withdrawing treatment that has become burdensome to the patient. However, the Bill does not say that. Clearly, a doctor's main purpose might be to withdraw treatments that are burdensome. However, if they know for certain that life will consequently end, what could their other purpose be? The Bill as drafted asks us to judge situations not according to the burden on the patient, but according to the doctor's purpose.

The issue is of course relevant not only to adults. Sadly, children may also suffer from illnesses, such as cancer, that may bring their lives to a premature end. When a young child--too young perhaps to understand what is happening to him or her--is seriously ill, the child's parents may be faced with agonising decisions. The child should of course be involved as far as possible in the decision-making process, but, if he or she is unable to be involved, the rights and best interests of the patient should be considered. The present law is based firmly on those rights.

The parent must exercise the decision-making power for the welfare of the child, in the child's best interest. If further treatment has little chance of success and may place a great burden on the child--as with some types of chemotherapy for cancer--a parent may decide it is not in the child's best interests to undergo it. The courts can review the decision if the clinical team have doubts about the parent's choice, but they too will base their assessment on the welfare of the child.

The welfare of a child is not mentioned in the Bill which deals only with the doctor's intentions or purpose. As a result, when the child's death, although almost certain with treatment, is inevitable without it, the doctor may be held to have intended the child's death. The Bill covers only the doctor's intentions and makes no reference to the best interests of the patient.

The clinical professions recognise that the withholding or withdrawing of medical treatment is a particularly difficult and sensitive area of medical practice. That is one reason why the BMA issued guidelines in June last year.

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At present, decisions on withdrawing artificial nutrition and hydration from patients in a permanent vegetative state have to be reviewed by the courts, but those are not the only circumstances in which consideration may need to be given to those issues. That is why the BMA proposed additional safeguards.

When the courts considered the very sad case of Tony Bland, they considered whether artificial nutrition and hydration was part of medical treatment and care or something entirely different. I should emphasise that where a patient is capable of taking nourishment, it must always be offered.

Deeply divided views are held on the subject. The courts considered that artificial systems for delivering nutrition form part of the medical treatment or care of the patient. There is no doubt that such artificial systems can place burdens on patients--as a result of which it is not uncommon for patients in hospital to try and pull such tubes out.

Under the current case law, if artificial nutrition and hydration is agreed not to be in the best interests of the patient, to continue with it is unlawful. The Bill would change that.

Some hon. Members who disagree with the decisions made in the Tony Bland case, will be keen to support the Bill. Others--like the Government--strongly oppose euthanasia as the intentional taking of life. Many will be keen to support the Bill as a way of reaffirming their opposition to euthanasia. I hope that I have made it clear that the Bill would go further than that and shift the focus from the best interests of the patient to the purpose of the doctor. As a result, the Bill, as drafted, is unworkable in practice. For those reasons the Government are unable to support it.

2.3 pm

Dr. Liam Fox (Woodspring): The many fine speeches by hon. Members on both sides of the House have made the salient points in the debate, so I shall be brief. The House owes a debt of gratitude to my hon. Friend the Member for Congleton (Mrs. Winterton) for raising such an important subject.

I am not speaking in my capacity as shadow Secretary of State for Health, but purely in a personal capacity. I believe that no action is acceptable where the primary purpose is to kill. That is why I oppose in principle and vote against the death penalty, abortion and euthanasia.

As the hon. Member for Oxford, West and Abingdon (Dr. Harris) said, it is not simply a matter of the distress of a patient, but a fundamental question of morality and ethics. We need to distinguish between the purpose and effect of a treatment or the withdrawal of a treatment.

As a doctor, I accept the concept of double effect. I fully understand that to give a patient with terminal cancer a large dose of morphine which will make him more comfortable but shorten his life span is entirely acceptable. The purpose of the treatment is to make the patient more comfortable although the ultimate effect may be to shorten life. I do not have a moral problem with that. However, so-called mercy killing crosses the line because the purpose is to cause the death of the patient. It is part of the ratchet effect that would push us towards full involuntary euthanasia. As my hon. Friend's Bill seeks to protect us against that, it should proceed in Parliament.

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I have the greatest respect for the BMA and I understand why it brought forward the guidelines, but I do not agree with them. Membership of the BMA is not compulsory for doctors in the way membership of a medical defence society is, and I hope that we are willing to make that distinction.

Most of all, there has been a confusion in the debate between ethics and morality on one side, and legality on the other. Legality is a moveable feast, whose direction is decided by the judiciary or by elected representatives. What is legal or illegal may be fluid, but basic morality is not. Because the majority say something is legal, it may be so. Because the majority say something is right does not make it so. The difference between right and wrong is not part of the democratic process, but part of a much higher order.

I hope that the Government will not use procedure or their parliamentary majority to kill the Bill. It is, literally, a vital moral argument. It crosses the party political divide and should be fully played out in the House. Our constituents will judge accordingly.

Mrs. Ann Winterton rose in her place and claimed to move, That the Question be now put.

Question put, That the Question be now put:--

The House divided: Ayes 113, Noes 2.

Division No. 54
[2.11 pm


AYES


Amess, David
Ancram, Rt Hon Michael
Anderson, Donald (Swansea E)
Atkinson, Peter (Hexham)
Beggs, Roy
Beith, Rt Hon A J
Bell, Martin (Tatton)
Bell, Stuart (Middlesbrough)
Beresford, Sir Paul
Bottomley, Peter (Worthing W)
Brazier, Julian
Burnett, John
Burstow, Paul
Butler, Mrs Christine
Cable, Dr Vincent
Canavan, Dennis
Casale, Roger
Chapman, Ben (Wirral S)
Chope, Christopher
Clarke, Rt Hon Tom (Coatbridge)
Collins, Tim
Cormack, Sir Patrick
Cox, Tom
Crausby, David
Curtis-Thomas, Mrs Claire
Darvill, Keith
Davies, Quentin (Grantham)
Dawson, Hilton
Day, Stephen
Dobbin, Jim
Donaldson, Jeffrey
Duncan Smith, Iain
Edwards, Huw
Faber, David
Forth, Rt Hon Eric
Fox, Dr Liam
Gale, Roger
Galloway, George
Gardiner, Barry
Gill, Christopher
Gray, James
Green, Damian
Grieve, Dominic
Gummer, Rt Hon John
Hammond, Philip
Harris, Dr Evan
Heald, Oliver
Heath, David (Somerton & Frome)
Hogg, Rt Hon Douglas
Horam, John
Howard, Rt Hon Michael
Howarth, Gerald (Aldershot)
Hoyle, Lindsay
Hunter, Andrew
Iddon, Dr Brian
Jenkin, Bernard
Jones, Helen (Warrington N)
Kaufman, Rt Hon Gerald
Kelly, Ms Ruth
Kilfoyle, Peter
King, Andy (Rugby & Kenilworth)
Lansley, Andrew
Lawrence, Mrs Jackie
Laxton, Bob
Leigh, Edward
Lewis, Dr Julian (New Forest E)
Lilley, Rt Hon Peter
Llwyd, Elfyn
Lyell, Rt Hon Sir Nicholas
McAvoy, Thomas
McCartney, Robert (N Down)
McGrady, Eddie
Mackinlay, Andrew
McLoughlin, Patrick
McNamara, Kevin
McNulty, Tony
MacShane, Denis
Maginnis, Ken
Malins, Humfrey
Marsden, Gordon (Blackpool S)
Mawhinney, Rt Hon Sir Brian
Morley, Elliot
Olner, Bill
Paice, James
Paisley, Rev Ian
Pickles, Eric
Pollard, Kerry
Pope, Greg
Pound, Stephen
Prentice, Ms Bridget (Lewisham E)
Randall, John
Redwood, Rt Hon John
Roe, Mrs Marion (Broxbourne)
Ryan, Ms Joan
St Aubyn, Nick
Sayeed, Jonathan
Shepherd, Richard
Singh, Marsha
Smith, Angela (Basildon)
Spicer, Sir Michael
Swayne, Desmond
Taylor, John M (Solihull)
Taylor, Sir Teddy
Thompson, William
Trend, Michael
Twigg, Derek (Halton)
Wardle, Charles
Webb, Steve
Whitney, Sir Raymond
Widdecombe, Rt Hon Miss Ann
Williams, Mrs Betty (Conwy)
Winterton, Mrs Ann (Congleton)
Winterton, Nicholas (Macclesfield)

Tellers for the Ayes:


Rev. Martin Smyth and
Mr. Joe Benton.


NOES


Harris, Dr Evan
Kirkwood, Archy

Tellers for the Noes:


Mr. Crispin Blunt and
Mr. Joe Ashton.

Question accordingly agreed to.

28 Jan 2000 : Column 751

Question, That the Bill be now read a Second time, put accordingly and agreed to.

Bill committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).


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