Standing Committee C
Wednesday 16 February 2000
[Mr. Roger Gale in the Chair]
The Chairman: Before we begin the debate on clause 2, I must tell the Committee that the clause is infinitely more precise in its wording than clause 1, which was more wide ranging. The amendments tabled to clause 2 are also more precise. I therefore propose to confine the debates more rigidly to the matter of the amendments, and, depending on how the debate progresses, to permit a clause stand part debate at the end of the debates on the two amendments.
Mrs. Ann Winterton (Congleton): I beg to move amendment No. 2, in page 1, line 14, leave out 'suffering from' and insert 'with a'.
The amendment is a simple, housekeeping measure designed to tidy up clause 2, in that it proposes leaving out "suffering from" and inserting "with a". It would simplify and clarify the Bill, and remove any possible ambiguity that might have been caused by the words "suffering from". The question whether a patient is suffering from any mental or physical illness could be open to interpretation. The amendment would remove any ambiguity, and I trust that the Committee will ensure that it is passed.
Amendment agreed to.
Mrs. Winterton: I beg to move amendment No. 3, in page 1, line 16, leave out 'the provision of'.
This is a similar amendment, in that it is brief and easily understandable. It is designed to simplify and clarify the Bill, and to remove any ambiguity that may be caused by the words "the provision of". A key principle of the Bill is that nutrition and hydration do not constitute medical treatment. There has been much debate about that, both on Second Reading and, earlier today, in Committee. The amendment is designed to focus on the essential elements of that principle, and to remove any question that may be raised about the use or interpretation of the words "the provision of".
Amendment agreed to.
Clause 2, as amended, ordered to stand part of the Bill.
Short title commencement, and extent
Dr. Brian Iddon (Bolton, South-East): I beg to move amendment No. 4, in page 1, line 20, leave out
'at the end of one month beginning with'
The Chairman: With this it will be convenient to discuss the following amendments: No. 5, in page 1, line 20, leave out 'one month' and insert 'six months'.
No. 6, in page 1, line 20, leave out 'month' and insert 'year'.
Dr. Iddon: These are probing amendments, designed to discover whether hon. Members are happy with the time scales involved. I understand that it is usual for a Bill to be enacted within a month, once it has completed its passage through Parliament. However, because so many people would be affected by this Bill, we decided to probe the possibilities of both a shorter and a much longer period of time.
I have tabled the amendments to generate a discussion. I am happy with the period of a month, but I believe that hon. Members will welcome the opportunity to discuss the question of time scales.
Mr. Joe Ashton (Bassetlaw): I have tabled one of the amendments in the group. You have caught me on the hop, Mr. Gale. I did not expect the Committee to reach this stage of the proceedings quite so quickly.
We must consider the consequences of the Bill that would arise not only immediately after an accident, but in the long term, for which hospitals would have to prepare. There was a full investigation of the doctor's dilemma in The Sunday Telegraph. It went into the Bland case in great detail. It stated:
"There are estimated to be some 600 or 700 new cases of this in Britain every year, with 1500 to 2000 such cases alive at any one time. Each has the prospect of filling a hospital bed, and their relatives' lives, for many years: the longest term is 36 years, according to the Guinness Book of Records."
That can mean many thousands of people existing perpetually in a coma, as Tony Bland did. He was kept alive for three or four years. It continues:
"The open-eyed, spastic, persistent vegetative state Tony Bland is in is different from a true coma--the sleep-like state that is assessed worldwide according to Professor Bryan Jennett's Glasgow Coma Scale."
Professor Bryan Jennett is an acknowledged expert in deep coma. He said:
"Many people recover from deep coma, but they will do so in weeks rather than months. Those who are left vegetative open their eyes in a few days or weeks."
They are not in a coma forever--they can keep opening their eyes, but cannot communicate. Professor Jennett continued:
"Understandably relatives may cling on to hope, particularly after reading newspaper reports of car crash victims who seem to wake up at the sound of a favourite Jason Donovan tape".
A picture from a film that victims had enjoyed in the past has also worked. Such people can recover from the coma; there is no doubt about that. However, Professor Jennett said:
"when we hear of people emerging from comas after a long period, it may be because they were in a viral or drug-induced state, or they may have suffered an injury to the brain and either the injured part has recovered, or another part has taken over some of its functions."
Although such people come round, they will probably be severely disabled for the rest of their lives. Professor Jennett commented:
"No one has ever come out of a year-long coma, although they have perhaps come out of one very slowly over the course of a year."
Tony Bland suffered a severe head injury combined with damage caused by lack of oxygen, when he was squashed for perhaps 20 minutes against a metal barrier. He could not get on to the pitch at Hillsborough to escape the crush, people were running down the tunnel in hundreds and thousands, some of whom were intoxicated--not the victims but those who came in late when the doors were opened and who did not have tickets--and he was subjected to a long persistent crush. The article in the The Sunday Telegraph also quoted an anaesthetist, who said:
"Within 24 hours tests may show such that such a person is brain dead. In the UK this is equated with the patient's death; we are legally entitled to diagnose death and switch off the ventilator. But if the patient is breathing unaided, he is not brain dead. The cortex of the brain is damaged, unable to function in a normal, human way, without hearing, sight or thought processes--but the primitive systems are maintained. This is the persistent vegetative state."
Nobody has ever come out of that state after a year. Tony Bland's neurologist commented on the cruel emotional and legal limbo for the patients' families. Parents suffer distress as they see their children grow older--Tony Bland was only 18 at the time. Their children are unable to recognise them. Such parents will know that this Bill could keep their children in such a state until they are 50 or 60 years old. Mr. Gale, I was about to say, "God in heaven", but how inhuman that must be! Does the hon. Member for Congleton (Mrs. Winterton) not realise the effect of the Bill on families who, year in and year out, have to visit relatives who are living in a vegetative state?
Mr. Michael Trend (Windsor): I accept that Tony Bland's family, and others who cared for him, must have been hugely distressed, but it is a delicate balance. The distress and desperation of such people must be considered alongside the distress of those people who believe that their relatives are being allowed to die of starvation as a result of the Bland judgment, or who have evidence that that is the case. Good and bad can be found on both sides of the argument in this context. We believe that, although the suffering of the Bland family was a high price to pay, it is outweighed by the suffering and anxiety of all the people who are concerned that the Bland judgment led to a form of compulsory euthanasia.
Mr. Ashton: With all respect to the hon. Gentleman, that would mean that we were playing God. There is one problem for such families. At any one time, 300,000 people are terminally ill. Nottingham has a population of about 300,000 people. Those figures have not been challenged, although they are constantly changing and will probably rise. If the amendment is agreed to, adequate provisions will not be available to deal with the one-month requirement. Hospitals will have to take budgeting and financial decisions, and, for example, decide whether such people should be kept together in one unit. Adequate preparations cannot be made in one month.
Mrs. Ann Winterton: The hon. Gentleman said that 300,000 people in the United Kingdom might at any one time be suffering from terminal illness. Most of those people will be treated in hospices or in their own homes with the help of Macmillan nurses or others who are experienced in palliative care. Those patients would not appreciate it if they had to be put down, so to speak, for inconvenience or for other reasons. The best response to the fact that so many people are terminally ill is to improve and increase palliative care. The situation in Holland shows what happens when one goes down the slippery slope. I accept that, sadly, we may have to say no in a few hard cases, but we do so in the best interests of the majority, including those 300,000 patients, whose care will not be altered if the Bill is enacted.
Mr. Ashton: I am sorry that the hon. Lady referred to Holland--it is always dragged into such debates. Whenever that country is mentioned, I always think of Green and Orange, Catholic and Protestant, and arguments that go back 300 years. We should not let that example colour our approach.
The hon. Lady never discusses the rights of the patient. We are told about a doctor's right to save a life, but what about the terminally ill patient who has had enough? He is not in a position to get out of his bed, go down to the chemist and buy 10 bottles of aspirin. He cannot throw himself under a bus, tie a tube to a car and gas himself in a garage or drown himself. Suicide has not been a crime since 1961, but assisted suicide is a crime, and that is what frightens doctors. I know that the hon. Lady will disagree, but I believe that a person has a right over his own life. Likewise, in relation to abortion, what happens inside a woman's body is her business and no one else's. What happens to the life of a patient who is terminally ill is his business. It is for him and for no one else--not the state or the legal system--to decide when it should be ended.