---

Mr. Paul Goodman (Wycombe) (Con): The hon. Member for Wyre Forest (Dr. Taylor) has been extremely sensitive to the mood of the debate, and to the atmosphere of gathering concern that some of us feel. I am going to be brief, as I want to allow my hon. Friend the Member for South-West Bedfordshire (Andrew Selous) time to speak, but I begin by saying that much of the discussion that we have had has rightly focused on the concept of autonomy, and on the apparent ideal of the autonomous individual controlling his or her own destiny in general, and his or her medical treatment in particular.

I want to stand back and to think about the concept of autonomy in the context of the Bill. In a perfect world, autonomy would be unimpaired. A man or woman would be in control of their autonomy, and would be able to anticipate every circumstance. Their mind would always be clear, and the information on which they acted would always be complete. They would therefore be able to anticipate the future. In that perfect world, the motives of third parties would also be benign. However, we do not live in that perfect world. Circumstances cannot always be anticipated, minds are not always clear, information is not always complete, the future cannot always be anticipated and, unfortunately, the motives of third parties are not invariably benign. This is a tribute to the complexity of human things.

All this is true of those of us who have capacity. My hon. Friend the Member for Daventry (Mr. Boswell) was quite right to stress that the Bill deals with real people in the real world, and that those of us who have capacity should bear it in mind that we know people who lack capacity, and that we ourselves will almost certainly be incapacitated one day. If all this is true of people with capacity and of those who are incapacitated, it must also be true when the autonomy of people who are to some degree incapacitated is transferred to an attorney or deputy in the way that the Bill sets out. It is to that aspect of the Bill that I want briefly to refer.
 
11 Oct 2004 : Column 104
 

I am not a medical expert, but I have listened to some very moving speeches today by hon. Members who know a great deal about medicine or who have seen their own relatives suffer. I have to refer in passing to what I think we would all agree was the speech of the debate, that of the hon. Member for Crosby (Mrs. Curtis-Thomas). It must be possible, as the hon. Lady said—and as the hon. Member for Heywood and Middleton (Jim Dobbin) reminded us in his speech—for an attorney or deputy with authority over life-sustaining treatment to be confronted by a medical dilemma that the patient had not anticipated or that he or she was uncertain how to deal with. In those circumstances, it is possible that the attorney or deputy may not understand what the patient wants or would want, for a hundred or a thousand different reasons. He may have misunderstood the wishes of the patient, and it is possible that he may have had some sort of disagreement with the patient since being given an advance directive or being given power of attorney. He may not know, as was illustrated by the hon. Member for Crosby (Mrs. Curtis-Thomas), that the patient or person does not want food or water withheld. If that person is not an attorney but a deputy appointed by the court who has no particular knowledge of the person in question, and who is sensitive to the demands and requirements of the state, and realises that state resources are limited, there are particular sensitivities and dangers for disabled people.

I speak with some wariness, wearing my hat for a minute as shadow Minister for Disabled People, as I know that, on issues affecting disability, there are nearly as many opinions about any one measure from disabled people as there are disabled people. A number of contributors to the debate, including my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning), reminded us that the treatment of disabled people in hospitals and other places is not always all that it might be. The hon. Member for Bolton, South-East (Dr. Iddon) was right to remind us of the concerns of the I Decide coalition, particularly, as I understand it, with regard to the issue of authority being transferred to deputies. Those concerns are serious, because of the rather loose definition of best interests in the Bill, which my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) and my hon. Friend the Member for Gainsborough (Mr. Leigh) explored at length. It is clear that best interests will not be medical best interests, and that attorneys will have the statutory right to refuse treatment on behalf of patients.

The Government have a reasonable riposte: the Minister could point out that under the Bill, doctors can change the decision of an attorney or deputy if they feel that it is being taken for the wrong reasons. I share the concern of my right hon. Friend the Member for Chingford and Woodford Green that in practice that may not happen. It may not happen because doctors may not have the time or inclination, or because they may be wary of a long court battle.

Some of us therefore fear that we are standing on our old enemy: the slippery slope. In those circumstances, Ministers always like to assure us, using another cliché—now that I have used that of the slippery slope—that we are not crossing the rubicon. That phrase is often heard in such circumstances. The Minister made
 
11 Oct 2004 : Column 105
 
that point in a general way when introducing the Bill. That response does not quite convince me, however, that the Bill will not allow the practice of euthanasia by omission, which already takes place—many speakers have referred to the long-rolling effects of the Bland judgment—and that we would not be crossing a rubicon were we to vote for the Second Reading of the Bill. Some of us have been assured by Ministers previously in relation to abortion and genetic experimentation, for example, that we are not crossing a rubicon, only for us to be told later, often by the same Minister, that we have already silently crossed that rubicon, and it is now too late to do anything about it.

I am in a slight dilemma about what to do tonight, given that there is a clear danger of euthanasia by omission under the Bill. Part of me would like to send a strong signal to the Government that they ought to introduce amendments to deal with that point, and to deal with the concerns about advance directives. Those considerations should lead me to vote against the measure but I am mindful that there are good things in the Bill and I do not want to delay them. I shall therefore follow the lead of the hon. Member for Crosby and abstain. Unless the Government table amendments in Committee to deal with the serious concerns that have been outlined, I fear that I may have to vote against Third Reading.

It is not up to my right hon. Friend the Member for Chingford and Woodford Green, other hon. Members or me to prove that our fears are reasonable but up to the Government to prove to us that they will not be realised. They have much work to do on the Bill and I hope that it can be presented in a greatly improved form on Third Reading.

9.15 pm

Andrew Selous (South-West Bedfordshire) (Con): It is tremendously important for us to recognise the good motives and intentions of everyone who has spoken in the debate. Although I have serious reservations about the measure, I acknowledge the Government's good motives and intentions on such a contentious subject. As many hon. Members have said, we all salute the Government for trying to grapple with it so that statute law catches up with case law and practice.

I also agree that we should speak about the issue with humility and care, as the hon. Member for Cannock Chase (Tony Wright) said in his opening remarks. Although many of us approach the subject with great passion and strong feelings, we should remember the hon. Gentleman's words. Like many hon. Members who have spoken, I have some experience. Some 24 hours before my mother died, my sister and I had to make difficult decisions. They are never easy and any of us could face them. Care and humility are therefore important.

At the outset of my remarks, I want to say that there are circumstances in which we should not strive officiously to keep alive—I believe that that is the phrase—and artificially prolong life for a day or two, causing huge discomfort to someone who would die in a short space of time. The Bill should not be about that.

My fundamental problem with the measure is that there are too many unanswered questions. Sadly, a great lack of clarity remains. This afternoon's debate has
 
11 Oct 2004 : Column 106
 
shown that through the widely differing interpretations of the Bill's effects. That genuinely worries me. When I came to the House today, I believed that I would probably abstain, but my worries are so great—as a result of partly what I have heard and partly my experience as a veteran of one or two Standing Committees, when the Government did not listen to the arguments with as much good will as they might—that I shall vote against Second Reading. I want to send a slightly stronger warning shot than a mere abstention would convey.

I share the worry, which many people expressed, that case law as reflected in the Bland judgment will be partially enshrined or upheld in the Bill. The measure also appears to uphold in statute law the provisions of the General Medical Council to which Mr. Justice Munby objected in the Leslie Burke case.

Like all other hon. Members, I was moved by the speech of the hon. Member for Crosby (Mrs. Curtis-Thomas) and I make no apology for referring to it again. It was incredibly powerful. It highlighted the great danger of legally binding advanced directives. We learned from her contribution that, in some cases, people will make a legally binding advanced directive when of sound mind, definitely believing that that is their settled will on their future treatment, but when they are in a hospital bed on a ward, they wish to choose a different course of action. We heard how the hon. Member for Crosby's mother was fortunately just able to communicate her will by blinking to say that she wanted to live, but we have to think of cases where people perhaps will not be able to communicate that.

That was the first thing I learned from the hon. Lady's contribution. The second was—she described it more clearly perhaps than others have in the debate— what a painful and distressing way to die the withholding of food and fluid is. We need to think hard about the dryness of the mouth, the desperate need for the mouth to be wet and not being able to remedy that situation.

I worry too about the time constraints that will be placed on the nurses, doctors, medical professionals and clinicians who will have to take these decisions. My right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) spoke of the pressures that many of our health service professionals work under. I worry that, with the advance directives, the attorneys, the deputies, the concern about what the courts will say about what they do and do not do, the true patient benefit will not always come to the fore because of the time constraints. It is important that the withholding of food and fluid be excluded from "treatment" in the Bill.

I go back briefly to the case of the 83-year-old lady in Florida. It is a distressing incident but it is important to focus on it to ensure that such incidents could not happen here. She suffered a stroke and was left with a severe physical disability, which included difficulty in swallowing. A feeding tube was inserted so that she could receive nourishment. Some three years earlier, she gave her brother power of attorney in respect of her health. He directed that the feeding tube was to be removed and that is what happened. She became hungry and repeatedly asked those caring for her in the nursing home for food but the ethics committee of the hospital decided that the order was clear. As a result, to quote the
 
11 Oct 2004 : Column 107
 
Washington Post of 5 January 1997:

"Until her death more than 10 days later, Nighbert was restrained in her bed to prevent her from raiding other patients' food trays."

That is a deeply distressing case. During the debate, I have listened hard to try to find some guarantee that there will be absolutely no way that anything like that could happen in this country, should the Bill become law. I have not been reassured during the debate or by what the Minister said.

As many hon. Members have said, there is a worry that this is euthanasia by omission. I do not speak as a Catholic but it is worth noting that the Pope recently defined euthanasia as

"an action or omission which of itself and by intention causes death".

It is significant that the past president of the World Federation of Right to Die Societies, Dr. Helgha Kuhse, has said:

"If we can get people to accept the removal of all treatment and care—especially the removal of food and fluids—they will see what a painful way this is to die and then, in the patient's best interests, they will accept the lethal injection."

That resonates with many points that have been made today.

On medical research, where such research is purely a question of assembling a database history or of observing the patient concerned, I see no legitimate objection, but if such research is invasive or in any way intrusive, it is a step too far. On behalf of the people whom we are discussing, we must look very warily indeed at granting this or any future Government such powers.

The Bill's use of the phrase "best interests" has been criticised frequently today. I would like it to be replaced by a reference to the "life" of the person concerned, along with a reference to their health and "clinical" best interests. I hope that we can do at least as well as the Scottish Bill; it uses the term "benefit", which is much more direct.

---