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Ms Munn: Is it not the case that an independent consultee would act in the person's best interests, whereas an advocate helps the person to express their own wishes and feelings, which might not be what some people would deem to be in their best interests? They therefore play a completely different role.

Mrs. Humble: My hon. Friend makes a fascinating point, which takes us back to a point made by the Minister earlier. My hon. Friend and I could make an unwise decision, and people could say, "Why did they do that? I don't agree with them." We have to recognise that the individuals covered by the Bill will also sometimes make unwise decisions. The independent advocacy service might well simply say that, although it might seem unwise to everyone else in the room, Mr. X—or P, in the terminology of the Bill—actually wants to make that decision. We have to allow them to make unwise decisions.

My hon. Friend has highlighted the difference between advocates and independent consultees, whose role seems to be to say what is in the best interests of the individual. Such details should be explored at a later stage, but I worry that clause 34(6)(a) says that an independent consultee

"may interview in private the person in relation to whom he has been asked for advice".

I would definitely want them to interview the person in private. I remain convinced that independent advocacy services have a vital role to play, and I hope that the Minister will re-examine the Joint Committee's recommendation that provisions similar to those in section 2 of the Health and Social Care Act 2001 be considered for inclusion in the Bill.

Ninety per cent. of the Bill is excellent. It provides support and safeguards for vulnerable people in the community, but there are one or two areas that the Government need to look at. I have mentioned euthanasia, and we need to consider how the Burke ruling affects the legislation, and whether there are more ways in which the Government can tighten up the wording to ensure that there is no confusion as to their intentions.

I am pleased that the Government have tightened up the provisions on advance directives in the way that the Joint Committee suggested. I have corresponded with Lord Filkin on this matter, and I was reassured by his reply, which stated:

"The Code of Practice will recommend that advance decisions should be made in writing and witnessed by someone independent, discussed with the health care professional and regularly reviewed and updated."

When a person with a degenerating condition is first told of their illness, they could be so horrified by the prospect of approaching the end of their life that they might make an advance directive without properly thinking through the consequences. They need to seek professional advice on health care in such circumstances, and to review it from time to time. Amazing medical advances are being made, which individuals cannot anticipate, but which they might need to take into account.
 
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Research has been mentioned in the debate, and it is an issue that the Joint Committee looked at very carefully. The hon. Member for Daventry (Mr. Boswell) talked about individuals being offered up for research. That conjures up nightmarish images for me; I have to say that, when the Joint Committee was considering this matter, I was reminded of Frankenstein images. We received compelling evidence from a variety of people, however, and it was suggested that research into certain conditions can simply involve observing an individual. It does not have to involve anything invasive. We also received assurances about the role of the medical ethics committee. However, the Government will have to look very carefully at the implications of the clauses dealing with this issue.

Mr. Boswell: I am grateful to the hon. Lady for giving way, not least because I fear that I did not pay her the same courtesy during my remarks. Will she accept from me, in good faith, that my concern here is about the principle of how these things are to be done and, above all, the basis on which it is to be determined whether they are in the best interests of the individual? The Minister might want to look carefully at the distinction between an activity that is broadly neutral in terms of a patient's welfare—as observation would be—and an invasive action, which would be quite unacceptable unless it could be linked to a specific benefit to the patient concerned.

Mrs. Humble: The hon. Gentleman makes an interesting point, which will need to be explored in the context of remarks made by some of his colleagues about certain existing practices. We have been debating this issue as though it were in a vacuum, but it is not. Doctors are doing certain things now. The courts are making decisions on them now. It is about time that we, as legislators and parliamentarians, discussed the issue. All sorts of things are happening that many hon. Members are entirely unaware of.

I have already mentioned the interaction of the Bill with the provisions of the Children Act 1989, and we need to look at those issues. My final point concerns resources. The Bill will deal mainly with people in the community, and it will concern not only their informal carers but professional carers. There will therefore be resource implications for social services departments and for people in the independent sector who provide social care. An extensive range of training programmes will therefore need to be set up. A general awareness of the issues dealt with in the Bill will also need to be raised, and I hope that that will be one of the positive outcomes of the Bill.

This is an important piece of legislation, and we really must get it right. A lot of people will be affected by it, and we cannot afford to get it wrong. I look forward to having detailed debates on the issues in Committee, so that we can reassure the people who are worried about them, and say to those who have campaigned for the Bill for years that we are at last listening to them.

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The time available for this debate is not infinite, so perhaps hon. Members will have regard to the interests of their colleagues when making their contributions.
 
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7.9 pm

Mrs. Angela Browning (Tiverton and Honiton) (Con): I was pleased to serve on the Scrutiny Committee for this Bill, the thrust of which I broadly support. I support particularly the principles outlined at the beginning of the Bill and the assumption of capacity. Like others, however, I have concerns about the Bill, to which I hope Ministers will listen, and I hope that they will be prepared to amend it in Committee.

The Committee recommended that the Government consider the implications of independent advocacy, which the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), a fellow Committee member, has just raised. I support her concerns because I do not share the Government's view that there is already adequate independent advocacy to meet the challenge of the Bill. If the Bill is to work, it must mean more opportunity for more people to access independent advocacy, which must be of the best quality, from people in sufficient numbers, to deal with casework in a timely fashion. All the logistical implications of the Bill, in terms of the demand for independent advocacy, can only be met if the Government clearly identify that more resources will be directed throughout the country to provide advocacy services for people who need them.

I declare an interest: the Making Decisions Alliance has been mentioned many times in this debate, and I am a vice-president of two charities that are part of the MDA—the Alzheimer's Society and the National Autistic Society. In the Scrutiny Committee, I was particularly concerned about autism—the House will be aware of my interest in that area—and the elderly, especially those who develop appalling degenerative conditions in old age.

Today's debate has highlighted legitimate concerns, especially in relation to euthanasia and so-called living wills. In the Scrutiny Committee, it was our understanding that the Government had made a commitment that this legislation in no way opened the gate to any practices that are not covered by existing UK law, which makes euthanasia and assisted dying illegal. For that reason, when the Government responded to the Committee's report, they added clause 58 to the Bill, which is different from the draft Bill, to make that crystal clear. Like the hon. Member for Blackpool, North and Fleetwood, however, I have concerns, because while there may be a moral dilemma in relation to the more high-profile cases that have gone to court—of people who have had severe accidents and been struck down in mid-life, but who have been kept alive in a so-called vegetative state—in some ways, identifying whether those might be outwith the Bill's scope is easier than identifying whether the many thousands of cases of people who simply reach the end of their natural life would be caught within its scope.

We heard of a moving case from the hon. Member for Crosby (Mrs. Curtis-Thomas), and although I shall not give a first-hand account, I had the experience, during the course of the Scrutiny Committee, of my mother dying over a period of four months in hospital. I was therefore dealing with a not dissimilar case. I am concerned about some of the conditions in our general hospitals in relation to the way in which the elderly are treated. I am not suggesting that they do not provide the
 
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treatment—if I may use that word—that is necessary; I am talking about general nursing care, which really comes into play when people end their natural lives.

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