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Mr. Speaker: I say to the right hon. Gentleman that all the amendments are there. My selection of amendments is published, and the House will know about them.

12.40 pm

Jim Dobbin (Heywood and Middleton) (Lab/Co-op): I beg to move, That the clause be read a Second time.

Mr. Speaker: With this we may consider the following:

New clause 2—Excluded decisions (No. 2)—

'(1)   Nothing in this Act authorises the withdrawal of palliative care.

(2)   "palliative care" includes the provision of—

(a)   relief of pain, suffering and discomfort;

(b)   nutrition and hydration, however provided.

(3)   The provisions of subsection (1) do not apply to—

(a)   a decision that nutrition and hydration is to be discontinued because it would be unreasonably burdensome to the person; or

(b)   the power of the court to make such order concerning the continuance of life sustaining treatment as it considers to be in the best interests of a person whom it has determined to be irreversibly unconscious.'.

New clause 4—Palliative care—

   'Nothing in this Act authorises the withdrawal of palliative care.'.

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Amendment No. 46, in clause 1, page 1, line 16, at end insert—

'(7)   An act done, or decision made under this Act by any person acting in a professional capacity, or for remuneration, for or on behalf of a person who lacks capacity must:

(a)   not be done in a way that is less favourable than the way in which it would be done or made for, or on behalf of any other person who lacks capacity, or for a person who had capacity, in a comparable situation,

(b)   be done without prejudice to the person's age, sex, sexual orientation, disability, religious persuasion, racial origin, cultural and linguistic background and membership of any ethnic group.'.

Government amendments Nos. 3 and 4.

Amendment No. 1, in clause 4, page 2, line 4, at end insert—

'(3A)   Where the determination concerns or affects the person's personal welfare, he must consider the person's life and health as basic to that welfare.'.

Amendment No. 45, in page 3, line 3, at end insert—

'(4A)   This must include the provision of communication support appropriate to the person, in particular in relation to the matters mentioned in section 4(5).'.

Amendment No. 2, in page 3, line 3, at end insert—

'(4A)   He must, where the determination relates to life-sustaining treatment, begin by assuming that it will be in the person's best interests for his life to continue.'.

Government amendment (a) to amendment No. 2, in line 2, leave out 'best'.

Government amendment No. 5, in page 3, line 27, at end insert—

'(   )   "Relevant circumstances" are those—

(a)   of which the person making the determination is aware, and

(b)   which it would be reasonable to regard as relevant.'.

Amendment (a) to Government amendment No. 5, in line 2, after 'determination', insert 'acting with due diligence'.

Government amendments Nos. 37, 38 and 6.

Amendment No. 32, in page 14, line 10, leave out clause 24.

Amendment No. 42, in clause 25, page 15, line 5 at end insert—

'and it was explained to P before reaching his decision that the withdrawal of the treatment in question might include the withdrawal of artificial nutrition and hydration.'.

Government amendment No. 39.

I call Iain Duncan Smith to move new clause 1. [Hon. Members: "Jim Dobbin."] I call Jim Dobbin.

Jim Dobbin: Thank you, Mr. Speaker.

It is important to say at the beginning that there are several very important amendments that colleagues want to discuss, and time is short. It is therefore important that we get on with the debate and reach as many of those amendments as possible.

Like many hon. Members, I welcome the Bill, which is long overdue and contains many good things that will benefit and protect those in a vulnerable position. As the Minister said, there has been genuine dialogue, which I have been part of, and some welcome changes have been made to the Bill, especially on clause 58, which
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makes it clear that the Bill does not change the law on murder, manslaughter or assisted suicide. I made that point on Second Reading, and it has been taken up.

Nevertheless, I still have concerns. One danger that needs to be addressed is that clause 58 would inadvertently allow euthanasia by omission. I know that that is not, and never has been, the intention, and that euthanasia forms no part of the Government's policy. That has been made clear in many statements over the last few years. However, if the wording in this area were strengthened, the danger of euthanasia by omission would be averted.

Unamended, the Bill would mean that those making proxy decisions to withdraw or to omit medical treatment could commit euthanasia without infringing clause 58. As it stands, if a proxy instructed a doctor to stop life-sustaining treatment, the doctor could do so with impunity because the purpose of his doing so would be to uphold the law which gives enforcement to the proxy's instructions. Even if the proxy had an unlawful purpose in making a decision to stop life-sustaining treatment, it would not be the proxy's decision that would cause death, but the doctor's action in withdrawing the life-sustaining treatment. Many proxies and decision makers would have been persuaded that because of the patient's feelings and values, death would be in the patient's best interests. They would argue that the lawful purpose of bringing about death by omission should be pursued. At present, under this jurisdiction only a court makes that decision and it is made only in rare and exceptional circumstances.

Unfortunately, if unamended, the Bill would allow proxies and decision makers to withhold life-sustaining treatment, including food and fluid, and in numerous circumstances. That would not be a problem if all decision makers and proxies were influenced by the purest motives and sought only the patient's best interests, but we know that in some cases the motive of proxies may be their own self-interest. What is best for the patient could be replaced by what is best for the proxy. A doctor does not have to challenge the proxy's decision in court if he or she feels that the withdrawal of life-sustaining treatment is not in the patient's best interests: who then is going to protect the patient? If we adopt new clause 1, doctors will be able to resist a proxy if they think, in their clinical judgment, that continuing treatment would be in the patient's best interests.

Mr. Kevin McNamara (Hull, North) (Lab): My hon. Friend will be aware of the statement made by the noble Baroness Warnock over the weekend in which she urged people going into homes to consider the financial implications for their relatives. Would not this be the start of a slippery slope towards the impure motives that attorneys or personal representatives might have, and to which my hon. Friend alluded? Did not the Baroness inadvertently do us all a favour by saying what the true interests of many people may be?

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