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Dr. Brian Iddon (Bolton, South-East) (Lab):
I commend the hon. Member for Southend, West (Mr. Amess) on his speech. He and I are two of the very few people who have debated euthanasia in the Palace of Westminster in the past few years.
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It would be hard to find anybody who would deny the basic premise underpinning the Bill—that all people have the right to make decisions for themselves, and that if they find that difficult they should be supported in the process. The Bill affects up to 2 million people, and 70 per cent. of them are being cared for at home. I had better make my position clear, as others have today. I am not a member of any pro-life group and I do not come from any religious grouping, but the subject has interested me for a long time—certainly since I came to Parliament in 1997—and I agree that the legal eagles and the medical specialists have been leading the debate in this area. I agree with the statement made by my hon. Friend the Member for Cannock Chase (Tony Wright) that it is about time that Parliament debated this important issue and came to conclusions.
I have several concerns about the Bill. My hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) made it clear how difficult it can be to communicate with some people—in her case, her mother. I am somewhat worried that busy medical staff and social workers—and, indeed, busy relatives and friends—will find it extremely difficult to spend the amount of time with patients that she obviously spent with her mother to try to get a decision out of her. Communication techniques are available, but some require specialist machinery and instruments. They are not available in all hospitals and certainly would not be readily available to the 70 per cent. of people without capacity who are cared for at home. If the Bill is enacted, I hope that we will recognise that fact and encourage people who are involved in health care and welfare to make more equipment available for communication with those with whom communication is most difficult.
I want to mention the very elderly in that respect. Such people are not always found in hospitals because many are cared for in residential and nursing homes. Many are unnecessarily heavily sedated—I stress the word "unnecessarily". It is impossible for an elderly and heavily sedated patient to make a sensible decision, so I want assurances that the Government will ensure that such people are safely and painlessly brought out of heavy sedation so that they can take the decisions that the Bill encourages them to make.
I am also worried about people who have capacity one minute yet lack it the next—of course I refer to the mentally ill. That is why I asked the Minister earlier why the draft Mental Health Bill and the Mental Capacity Bill are not going forward in parallel, despite the fact that there is clearly an important relationship between the two. It is important for us to consider that group of people because unfortunately it is not a small one.
I come now to the two dominant subjects of the debate: living wills and independent advocacy. I have been passionately against enshrining living wills in statute law for a long time—certainly since I was elected to Parliament—and have campaigned against them over the years inside and outside Parliament. Why do the Government want to enshrine living wills or advance directives in statute law for the first time, especially given that they took the opposite point of view only a few months ago? They appear to have done a U-turn, so I wonder why they have changed their opinion on living wills.
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The problem with living wills or advance directives is that whether we like it or not, they are closely associated with the Voluntary Euthanasia Society, which has frightened people for a long time about terminal conditions—at one time it was cancer, but now it is motor neurone disease. Although the Government say that they are against involuntary and voluntary euthanasia, and of course assisted suicide, the inclusion of clauses on advance directives or living wills in the Bill sends a strong signal to people who are campaigning to make voluntary euthanasia and assisted suicide legal in this country, as has happened in the Netherlands and Belgium, both of which are close to us. That is a reason why, despite the fact that the Bill has many good aspects, people are nervous about it. If the Government had stuck to their guns and stood by their statement of a few months ago that they would not enshrine living wills in statute law, the Bill would have been much better. I do not want the Bill to become the Trojan horse by which assisted suicide and voluntary euthanasia are legalised in this country. Mark my words: once it is on the statute book, there will be calls to amend it from people like the noble Lord Joffe in the other place.
Following the Bland case, which has been adequately covered, the British Medical Association and then, of course, the General Medical Council unfortunately defined artificial feeding and hydration as medical treatment. That was the single factor that set me on fire when considering the whole remit of people without capacity and in the debate on euthanasia. I thought that it was a grossly wrong decision. I still think that, and so do many other hon. Members who have spoken. I plead with the Government to reconsider that. It is not the medical professionals who should be defining terms of life and death, but this place and the other place—the two Houses of Parliament. I agree with those hon. Members who find it difficult to accept that withdrawing treatment such as artificial feeding and hydration, thereby starving and dehydrating someone to death, is not euthanasia. I know that the Government do not like to accept this, but starving and dehydrating a person to death by preventing them from having access to food and hydration is euthanasia by omission. I think that a court of law would agree.
I do not know whether any hon. Member saw The Observer on 19 September. The front-page headline was "Revealed: full scale of euthanasia in Britain". The sub-heading was "Fury as number of assisted deaths claimed to be 18,000". That is in the United Kingdom. It is what is frightening people and causing them to write to us about the debate.
Mr. Grieve: I agree that that is a concern. The hon. Gentleman may also share the concern, as suggested in my mailbag, that people complain about the quality of care accorded to the elderly terminally ill in hospital, although that is difficult to ascertain. Those complaints arise with great frequency and are increasing with the attitude that hastening the departure of those people is acceptable.
In the Bland case, Lord Justice Mustill noted:
"It is a striking fact that in 20 of the 39 American States which have legislated in favour of 'Living Wills', the legislation specifically excludes termination of life by the"
"withdrawal of nourishment or hydration."
That is a pretty significant statement. He went on to declare the practices of euthanasia by commission or omission as indistinguishable, something that the Government are unable to accept, at least at the moment. I hope that they will change their mind.
Another problem with advance directives is that people change their opinions as they age and as their circumstances change. They should be time-limited so that they cannot get out of date. The VES supports that, which is one thing in its favour. It is perhaps worrying that advance directives do not have to be in writing. They can be made orally by, for example, a patient who is being wheeled into the operating theatre. As long as the patient's wishes are recorded in the notes, the doctors will listen to an oral advance directive. So advance directives can be made either in writing or orally at almost the last minute. They reflect the wishes of the patient.
Mr. Ben Chapman (Wirral, South) (Lab): Does my hon. Friend agree that the notion of permitting people to die a horrible death by starvation and dehydration is difficult to accept, as is the concept of the legalisation of living wills? Does he agree that although there is some good in the Bill, it is difficult to see how it can be amended piecemeal without root and branch changes?
Dr. Iddon: I believe that the Bill can emerge at the end of the legislative process in a much better state than it is now and that that point can be covered. I do not want to go back 15 years. We must go forward with the Bill and make it work.
Let me say something about independent advocacy. I have been meeting representatives of I Decide, the alliance that represents seriously disabled people. It has some serious difficulties with the Bill. One of the things that it has asked me to flag up is independent advocacy. I will be arguing to the end of the legislative process that seriously disabled people must have the right to an independent advocate. Their parents, social workers or those in residential homes who may be caring for them may give them advice that they are not prepared to accept, and they have the right to be heard by an independent advocate who would push the case for them.
I will not vote against this Bill. I will vote for its Second Reading because I am extremely pleased that we are having this debate and I want to continue it in Committee. I have heard that the Government are to extend the time for consideration in Committee. I hope that they will repeat that in the winding-up speech, because we must have adequate time to debate all the difficult decisions. During my discussions with my noble Friend Lord Filkin, the Under-Secretary of State for Constitutional Affairs, my hon. Friend the. Member for Tottenham (Mr. Lammy) and the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), I believe that they have listened. I am convinced that they are operating from the best of intentions, but I hope that they take on board the criticisms that Members have made today as constructive, and that they are prepared to amend the Bill to make it acceptable to the vast majority in this country.
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I end with a quotation from Jacqueline Laing, who is a solicitor, a barrister and senior lecturer in law at London Metropolitan university. She said:
"By allowing a new category of agent power to withhold and withdraw treatment—which includes nutrition and hydration after the controversial decision in Airedale NHS trust v Bland (1993)—as well as power to authorise both non-therapeutic research on the mentally incapacitated and controversial procedures like non-voluntary sterilisation and abortion—now permitted by the Courts—the Bill endangers rather than empowers. Its overall aims are accordingly irreconcilable with the intrinsic dignity of every patient, however disabled or impaired."
The question is whether she is right. I hope that we can debate such concepts in Committee.
8.48 pm
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