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Mr. Miller: I have much respect for the hon. Gentleman's views on some of the difficult moral and ethical issues that arise both in this country and throughout the world. The other day, we took part in a debate on the matter in Westminster Hall. Am I following him correctly? Is he saying--I accept his analogy with the shoes and jogging--that purpose means intent and that, therefore, if the intent is clear, only one logical charge can be pursued under the Bill?
Mr. Leigh: Yes. Broadly, the hon. Gentleman makes a good point. That is why the new clause is important and interesting. It claims that the matter is so difficult that we will never be able to work out intent and that it somehow becomes a political issue that needs the participation of the Attorney-General or the DPP.
It makes an enormous difference both to the protection of patients and to the character of medical practice whether we allow doctors to aim at hastening the death of their patients, for if we think that it is an acceptable purpose for doctors to have, we are in effect inviting them to decide if and when their patients no longer have worthwhile lives. However, it is incompatible with a fundamental moral assumption of our law that people should be thought eligible to have their lives ended because someone has judged their lives no longer worthwhile. Hence the Bill declares unlawful the withholding or withdrawing of medical treatment or sustenance if it is part of one's purpose in doing so to end the life of the patient.
Let me deal with problems that have been raised by Members who are doctors in the House and by other doctors in the BMA--[Interruption.] I apologise for the term "Doctors in the House".
Mr. Bob Russell: There are three of them on the Liberal Democrat Benches.
Mr. McNamara: They are not a holy trinity.
Mr. Leigh: They are not. The hon. Gentleman is right.
The measure does not make unlawful the withholding or withdrawing of medical treatment if that treatment cannot or can no longer provide any therapeutic benefit, or if, in one way or another, it has become unduly
burdensome to the patient. Thus, it will be reasonable to discontinue artificial ventilation of a patient when all other therapeutic interventions have failed. Artificial ventilation is characteristically employed to keep a patient alive, providing doctors with an opportunity for therapeutic interventions designed to save the patient's life.On intent, the fact that death immediately follows the turning off a life-support machine is not part of one's purpose in discontinuing artificial ventilation, even if death is a foreseeable consequence of so doing. It is very important that we understand that point. If I turn off a life-support machine, a foreseeable consequence is that death will follow for the person on the machine. However, although that would be a foreseeable consequence, the action would not fall foul of the Bill because, quite clearly, my intention would not be to cause the death of the patient.
Dr. Jenny Tonge (Richmond Park): First, if one knows the consequence of an action, one surely knows that the purpose of that action is to deliver the consequence. There is no distinction. Secondly, is not artificial feeding akin to artificial respiration? If either is withdrawn, the patient will die.
Mr. Leigh: We do not contend that they are akin. That is why the Bland case was so important, and the judges themselves admitted that they had such difficulty in finding their way through that moral maze. The judges themselves reached the conclusion that there was no difference between omission and a positive act. They simply took the view that Tony Bland's case was not worth while. Tony Bland could breathe and digest food. The consequence in his case was not only foreseeable, but the result of a deliberate act.
Mr. Deputy Speaker: Order. The hon. Gentleman is making quite a complicated point that is more appropriate to Second Reading to justify his argument on new clause 10. Although I appreciate that, I should be grateful if he and other hon. Members could deal more directly with the new clauses in this group.
Mr. Leigh: I apologise, Mr. Deputy Speaker; I realise that we are on Report. I wanted to try to conclude my speech, but there have been several interventions. I had better not give way again.
I think that I have made my point, which is quite clear. Quite simply, nothing in the Bill obstructs good medical practice. Nothing in the Bill need inspire fear in doctors. It is not necessary for us to raise the matter to the political sphere and to involve the Attorney-General and the DPP.
Dr. Brand: Will the hon. Gentleman give way?
Mr. Leigh: No, I cannot give way. I could be called to order if I did.
All we have to do is simply to have a clear view on the worthwhileness of human life, and a clear view that doctors must not act or omit to act with the deliberate intent of ending someone's life or denying the inherent dignity of that life. The Bill is clear on those points. The new clauses are not necessary.
Mr. Ashton: I shall concentrate on new clauses 10 and 17, but especially on new clause 17. My hon. Friend the Member for Hendon (Mr. Dismore) has made many technical and erudite points--as they should be, because we are considering a matter of law--but we should also take into account the reasons why we are debating the Bill and some of its potential consequences.
As many people know, tomorrow is the anniversary of the Hillsborough disaster. On 15 April 1989, 96 young people were squeezed to death, with four more young people dying subsequently from the injuries that they sustained on that day. The disaster has led to 11 years of trauma, grief, analysis and debate--resulting ultimately in the Medical Treatment (Prevention of Euthanasia) Bill.
I was present at the Hillsborough disaster. I was no further from those who were crushed than you are, Mr. Deputy Speaker, from the Strangers Gallery. I saw everything that happened on that very sad day. Other hon. Members were there as eyewitnesses. Eddie Loyden, who is now retired, was at the ground and so were my hon. Friends the Members for Houghton and Washington, East (Mr. Kemp)--who was elected to the House in 1997--and for Nottingham, East (Mr. Heppell).
No one who went through that trauma could ever forget it. We gave evidence to the Taylor report inquiry, although not to the inquest. Just after the disaster, I became a director of the club. For many years, I have been very heavily involved in the matter and its consequences.
10.45 am
Arising from the disaster was the case, which has been mentioned many times, of Tony Bland, who was 18. He was starved of oxygen when he was crushed against the barriers for a considerable time. He was later diagnosed as being in a--it is a medical term--persistent vegetative state. His parents lived in Keighley, and he was cared for at Airedale general hospital.
About eight months after the disaster, Tony Bland's neurologist was informed by the Medical Defence Union and the district coroner that, if the doctor disconnected the feeding tube, under the law as it then stood, he could be open to a charge of murder or manslaughter.
The case dragged on for the next three or four years. In December 1991, Gary Waller, who was then the Conservative Member for Keighley, raised the issue in the House, but it did not result in a change in the law. Eventually, however, the law was changed. Let us be absolutely clear about it: the hon. Member for Congleton (Mrs. Winterton) wants to change the law, to restore the position that applied in 1989, despite all the consequences of that law.
The case dragged on to September 1992, when Tony Bland's parents and doctor decided to apply to the High Court for a ruling on withdrawing treatment. The regional health authority and the hospital backed their case, which was based on British Medical Association advice that artificial feeding was a medical treatment and could be withdrawn. Lawyers acting for the health authority backed the case.
There was a hearing in the High Court, in November 1992, and counsel for the Official Solicitor argued that, despite the health authority's request, it would be murder to cease treatment. In November 1992, Sir Stephen Brown, president of the family division, ruled that doctors may
- lawfully discontinue all life-sustaining treatment and medical support measures.
In their judgment, which was given on 4 February 1993, the Law Lords unanimously ruled that artificial feeding should be withdrawn. They called on Parliament to legislate on when doctors can stop "futile" medical treatment. They expressed great unease at having to rule in such a difficult sphere without legislative backing. However, they stressed that there was a crucial difference between withdrawing treatment and actively ending life. The ruling was backed by the BMA.
The Bill is intended to put the clock back to the position pertaining before the Law Lords' ruling. Although the issue has received the most intensive consideration at the highest level, the hon. Member for Congleton wants essentially to reverse that judgment.
New clause 17 deals with publicity. I am holding newspapers showing the type of publicity that Tony Bland's family had to endure. There were pages and pages of stories. For four years, every tabloid and newspaper--ranging from the most serious medical journals in the land down to the tabloids--talked about the anguish of that poor boy, who could not eat, speak, laugh or cry, and about whether he should be allowed to die. His parents sat there--day after day, year in, year out--suffering, and perhaps gaining hope whenever there was a sign that the boy might recover, but it was obvious that that would never happen. To get some mercy for their boy, they backed a legal saga that lasted years and in which lawyers analysed the issues. Imagine the anguish of the parents, when they are continually the subject of television documentaries and newspaper analysis. My hon. Friend the Member for Hendon referred to the abortion demonstrations in America outside hospitals or courts. Is that a humane way to treat a person in a deep coma, who probably has no life?
Doctors have a dilemma. Some of the foremost experts in the country have said that there are 600 to 700 new cases in Britain every year and, at any one time, there are between 1,500 and 2,000 people who might be kept alive for as long as 25 or 30 years. What a macabre situation!
Professor Bryan Jennett from Glasgow, an expert on comas, says that no one has ever come out of a year-long coma. Although some have perhaps come out of one very slowly over the course of a year, they may well be severely brain damaged.
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