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Ann Winterton (Congleton) (Con): It is a great privilege to follow the hon. Member for Crosby (Mrs. Curtis-Thomas). The House listened in absolute silence to what she had to say. It was very personal, very emotional and true.
I have always considered the Bill to be a mixed bag. It is like the curate's egggood in parts. However, in listening to the debate, especially the Minister's contribution, I have come to the conclusion that it is far more dangerous than I first thought. I am grateful for the fact that the hon. Member for Crosby spoke before me because I was privileged to have her support when I introduced my private Member's Bill, the Medical Treatment (Prevention of Euthanasia) Bill, in 2000. These issues were fully debated at the time, and the hon. Lady played a major part in debates both in the Chamber and in Committee.
At the time, I was accused of scaremongering because I referred to the suffering caused to patients by the withdrawal of food and fluids, however delivered. I was also ridiculed when I said that I was of the opinion that the withdrawal of assisted food and fluid, thus ending the life of a patient, is in breach of article 2 of the European convention on human rights. I am therefore deliberately beginning my speech by quoting the case of Mr. Leslie Burke. I know that he has been mentioned before. Mr. Burke challenged the legality of the General Medical Council guidelines that permit doctors to withdraw treatment, including assisted food and fluid, from mentally incapacitated patients. The guidelines are reflected in the Mental Capacity Bill, and I draw the attention of the House to the fact that the Disability Rights Commission supported Mr. Burke in his legal challenge.
When Mr. Justice Munby of the High Court family division ruled in favour of Mr. Burke, he stated that the guidelines are in breach of articles 2, 3 and 8 of the European convention on human rights. The all- party parliamentary pro-life group has consistently maintained that the GMC guidelines are in breach of article 2, which states:
"No one shall be deprived of his life intentionally".
That was one of the main points that we made in our submission to the GMC when it was receiving evidence on the issue. Moreover, among the points raised by Mr. Justice Munby was the fact that the withdrawal of assisted food and fluid from patients can cause pain, discomfort and extreme distress that results from
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malnutrition and dehydration. That is another crucial point that I and others have made persistently over the years.
There is no purpose in pretending that the withdrawal from a non-dying patient of assisted food and fluid, which is defined as treatment in clause 60, is not euthanasia. Professor Sheila McLean, a leading euthanasia lawyer, has made it clear that it is. In her paper published in the Voluntary Euthanasia Society of Scotland newspaper in April 1996 she described the Bland judgment that allowed the withdrawal of treatment, including food and fluid, to end the lives of those in a persistent vegetative state, as a form of involuntary euthanasia. Perhaps not so curiously, Professor McLean was a member of the drafting committee of the British Medical Association guidelines on withholding and withdrawing life-prolonging medical treatment that advocated the withdrawal of treatment along the lines adopted in the Bill.
Let us be clear about this: in justifying such treatment we have seen any number of words and phrases being given new meanings. One, which has already been mentioned, is the term "futile treatment". I would not want to see any patient, and certainly no patient that I loved, having futile treatment inflicted on them. To me, that means giving people treatment that can no longer help them, such as pumping a patient full of antibiotics when they are drawing close to death or operating on a cancer patient when there is no hope of curing or relieving the disease, but food and fluid, however delivered, have never been thought of as a treatment to cure a stroke, Alzheimer's disease, Hodgkin's disease or anything else. Such an idea is patent utter nonsense.
Food and fluid are, as the hon. Lady said, basic care that relieves hunger and thirst. What she did not say is that they prevent a patient from dying from starvation and dehydration. However, in some cases, such as advanced cases of Alzheimer's disease, assisted food and fluid are being described as futile treatment which can be withdrawn, when in fact what is meant is that the patients are considered to be futilein other words, people who are not worth feeding. If Members of the House checked with the Disability Rights Commission they would find that an increasing number of disabled people are becoming more and more frightened of being admitted to hospital. With the growing ethos that some patients are not worth treatingthat they are futilethat is hardly surprising, and it should be brought to a halt by ensuring that the definition of treatment in the Bill excludes food and fluid, however delivered.
Another aspect of the Bill that I find frightening is that relating to the definition of "best interests". According to the Bill, this refers to the patient's wishes or, even worse, what somebody else considers would be the patient's wishes. Nowhere does the Bill refer to health or life, and it would allow decisions to be made that are clearly contrary to the patient's medical or clinical best interests. It is interesting that Scotland's Act, which is not without flaws, is a vast improvement on the Bill before us. The Adults with Incapacity (Scotland) Act 2000 refers to the patient's benefit. Why, I ask the Minister, can we not have the same simple and straightforward definition in the Bill?
The Scottish Act also differs greatly from the Bill in the matter of legally binding advance directives. The Act makes no reference whatever to such directives. As far
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as Scotland is concerned, they simply do not existyet for some unknown reason they are to be foisted on the English and Welsh public. That is even more surprising in view of the fact that in 1994 the House of Lords Select Committee on Medical Ethics, which considered euthanasia, also examined in depth the whole issue of advance directivesor living wills, as they are popularly called. The Committee took into account not only the right of patients to indicate what they would like to happen in given circumstances, but the very real dangers of making living wills legally binding in statute law. In its report, it welcomed the concept of advance directives, but advised against their being made legally binding in statute law.
Apart from the fact that old and mentally incapacitated people could well be manipulated into signing a document, because no one wants to be a burden, there is the real danger, no matter how carefully the law is framed, of people not really having a clear understanding of what they are declaring. For example, most people imagine that patients who have suffered severe strokes will simply die if not treated, but that is not so. Some years ago, Professor Peter Millard, then professor of geriatrics at St. George's hospital in London and president of the British Geriatrics Society, explained to a meeting of MPs and peers that a high proportion of people survive; those affected, if they are not given vigorous treatment after the stroke through which they often regain the capacity to move and walk, simply become very crippled and will, in all probability, lead extremely painful and limited lives, which could be avoided through early treatment following the stroke. That type of problem is recognised by many doctors. In the biggest and most recent survey of doctors on the issue of euthanasia, more than 71 per cent. said that there were circumstances in which they would refuse to follow an advance directive. Their concerns mirror those of MPs who oppose some aspects of the Bill.
In the Scottish legislation, all reference to legally binding advance directives has been omitted. Whatever reason is given for that, I can tell the House that the Scottish National party has an official policy of opposing the concept of legally binding advance directives because of the dangers, and it was pretty obvious that the party was prepared to do battle if such a clause were included in the Scottish Bill. I return to the thorny questions of why in Scotland is the definition of "best interests" so much stronger, and why we are being saddled with legally binding advance directives, which for so long have been an objective of the euthanasia lobby in this country.
Mr. Duncan Smith: Does my hon. Friend not think that the problem is that the Government are refusing to face the implications of the Bland judgment and of what is now happening in hospitals up and down the country? The difference between "benefit" and "best interests" is dramatic: use of "best interests" leaves the provision wide open to be defined by those who have power, rather than actually in the best interests of the patient in question.
My right hon. Friend made a strong speech earlier and he makes a pertinent point now. I am sure that those who read the debate in Hansard will agree with that point, as do I.
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With hon. Members on both sides of the House I have been involved in the pro-life fight in Parliament for many years. One of the most common tactics that we have encountered has been the fight to make changes to the law because of complaints about differences between England and Scotland. For example, in 1991 the BMA claimed that in Scotland it was able to apply to the procurator fiscal to obtain permission to withdraw treatment from patients in a persistent vegetative state, and that it was ridiculous to have such a difference in law between the two countries. However, when inquiries were made with the Lord Advocate's Department in Scotland, we learned that no such process existed and that, in any case, the procurator fiscal would not be allowed to make such a decision. The story does not end there. Shortly after the Bland judgment was given, a campaign began in Scotland claiming that in England applications could be made to the court to have treatment, including food and fluid, withdrawn from PVS patientsand, yes, it was ridiculous to have one law for England and Wales and another for Scotland. Not long after, the Law hospital case in Scotland resulted in a verdict similar to the one in the Bland case. I can envisage precisely the same scenario being played out around the definition of "best interests", with the Scots being told that patients' wishes are being denied and that they are being denied an opportunity to choose because advance directives are not to be made legally binding.
I warn the House that we are dealing with an ultra-cynical lobby, which will not stop with the Mental Capacity Bill. It will see the Bill as an opening of the door to legalised euthanasia by commission. If we are to retain the smallest vestige of respect for human life, we must not allow the Bill to pass without radical amendments to prevent the introduction through the back door of euthanasia by omission. Let me make it clear that I support certain sections of the Bill. Throughout, the all-party pro-life group has supported the principle of creating a statutory framework to protect those who lack mental capacity. Earlier, I had thought to abstain in any vote this evening, but having heard some of the speeches, I have concluded that parts of the Bill are inherently wicked and I have no path to take other than that of opposing it. I trust that in Committee, those radical amendments to which I referred are made. If they are, no one will be more pleased than I will.
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