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Jim Dobbin: Yes, I heard Baroness Warnock commenting on the matter on television. Those implications are the reason for tabling new clause 1, which would enable doctors to resist a proxy if, in their clinical judgment, they believed that continuing treatment would be in the patient's best interests. It would also allow doctors to withdraw treatment that is
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"unreasonably burdensome" to the patient. I hope that that shows that new clause 1 would not change existing law.

12.45 pm

Chris Bryant (Rhondda) (Lab): I believe that I am as opposed as my hon. Friend to euthanasia. However, what precisely does he mean by the phrase "unreasonably burdensome", which appears in new clauses 1 and 2?

Jim Dobbin: We do not want to subject the patient to undue hardship or pain—that is what "unreasonably burdensome" means.

New clause 1 would not change existing law.

Mr. Iain Duncan Smith (Chingford and Woodford Green) (Con): There is another aspect to "unreasonably burdensome". Let us take the case of someone in their last days who is likely to die and finds it uncomfortable to be fed or receive fluids. The new clause would allow withholding in those specific circumstances so that there would not be court cases or judgments against anyone. That covers one cause for concern.

Jim Dobbin: The right hon. Gentleman clarifies my comments.

The purpose of the new clause is to prevent the extension of the law to proxies and its widening to other circumstances that were not established in the original judgment. I am convinced that that is not the Government's intention, but that will be the effect if the Bill goes through without amendment. We need to close the loophole.

Mr. Frank Field (Birkenhead) (Lab): My hon. Friend says that widening the law is not the Government's intention. Would it not help all hon. Members if the Government clearly stated that, by medical support, they do not mean food and liquids?

Jim Dobbin: I agree with my right hon. Friend. That has been part of the discussion in the past year or so. We are anxious for those words to appear in the Bill.

Mrs. Angela Browning (Tiverton and Honiton) (Con): The hon. Gentleman knows that, on Second Reading and in our deliberations in Committee, the Under-Secretary was repeatedly asked to confirm or deny that the word "treatment" in the Bill included nutrition and fluid. He failed to do that. If he did that today, there would be much greater clarity in the debate.

Jim Dobbin: I hope that my hon. Friend the Under-Secretary has listened to the hon. Lady's comments.

The Parliamentary Under-Secretary of State for Constitutional Affairs (Mr. David Lammy): In the past few weeks, we have examined the specific difficulty that, although food, fluid and palliative care for someone in their dying stages is vital and doctors and nurses would fail in their duty if they did not offer comfort, especially through moistening the mouth, we all know old people
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who do not want tubes and feeding in those last days. Those people can make an advance decision that they do not want to be fed by tube. That is the central issue.

Jim Dobbin: That is a totally different matter.

We need to establish clearly and unambiguously that proxies and decision makers are not authorised to make decisions with the purpose of bringing about the death of the patient.

Mrs. Claire Curtis-Thomas (Crosby) (Lab): My hon. Friend has heard the views of my hon. Friend the Under-Secretary, who implied that the new clause is about imposing burdensome treatments on individuals at the end of their lives. Will my hon. Friend take the opportunity to restate that the new clause would not impose burdensome treatment but ensure that people who are comfortable in their condition receive hydration and nutrition rather than being starved to death or left to die of hunger?

Jim Dobbin: My hon. Friend is right that the new clause deals with that.

Although the Shipman case was exceptional, it shows how the unscrupulous can misuse a position of trust. The aim of the Bill is to provide security and sound legislation to protect the vulnerable. The intention is to benefit those who are not in a position to look after themselves. It is up to us to ensure that the wording is not detrimental to those whom we are trying to protect.

I stress that new clause 1 is not designed to overturn the Bland judgment, but I accept that there has been concern that it might. It is a declaratory provision and does not create any new criminal offence or civil wrong. If it did, it could be argued that it seeks to overturn the Bland judgment. However, that is not so. It is a declaratory provision that makes it clear that provisions with the purpose of causing death have no place in the Bill. New clause 2 (2) expressly reserves the power of the court to make decisions on withholding or withdrawing life-sustaining treatment, which is an important safeguard against the exercise of unscrupulous motives. We have not tabled new clauses 1 and 2 because we are vitalists and seek to preserve life at all costs. It is right that we should limit medical care where it will not work, where it is futile or when it is burdensome. Having worked in the health service for more than 33 years, I accept that that is done regularly in clinical practice.

It is, however, an entirely different matter to require that treatment and/or assisted food and fluid be withdrawn or withheld from patients who are not dying. If unamended, the Bill would allow that in certain circumstances. We are trying to protect the most vulnerable people. The question should always be, "Is the treatment worth while?"

Mr. Frank Field: I am grateful to my hon. Friend for allowing me to emphasise that those of us who are worried about this will support his amendments if necessary in the Lobby. His aim is not to keep people alive at all costs. We want people to die well, and we should not strive officiously to keep them alive when they are dying. However, we do not want to bop people off when they have quite a lot of life ahead of them. That
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is the emphasis of new clauses 1 and 2. If we do not receive a satisfactory response from the Minister, we should support my hon. Friend in the Lobby this afternoon.

Jim Dobbin: I agree.

I shall conclude, because many Members wish to take part in the debate. For the record, I would like to make the purpose of new clause 1 crystal clear. In The Times today, my hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) said that new clause 1 would leave doctors with no alternative but to keep people alive as long as possible. That is categorically not true. New clause 1 allows life-sustaining treatment, including assisted food and fluid, to be withdrawn in cases where it is futile or burdensome and where doing so would not interfere with good palliative care.

Mr. Lammy: Does my hon. Friend accept the advice of many oncologists or cancer specialists that some cancerous tumours are fed by artificial nutrition and hydration, and thus hasten death?

Jim Dobbin: The Minister has raised that issue with me in the past, but I do not agree with him.

Mrs. Browning: In the cases that the Minister mentioned, where a tumour is at an advanced stage and hydration and nutrition are withdrawn, inevitably, painkilling drugs have to be increased. As a result, the patient is unable to take sustenance through the mouth, but carers must still make sure that in their dying hours that they have moisture around the mouth. It is incredibly uncomfortable not to have hydration, even if it is not swallowed down.

Jim Dobbin: The hon. Lady makes the point very clearly.

I have spoken long enough on this issue because, as I have said, there are other important amendments to be discussed.

Mrs. Curtis-Thomas: My hon. Friend will have heard the Minister, who again implied that people would be forced to take hydration and food when it was blatantly obvious that that would be burdensome for them. Will my hon. Friend take the opportunity once again to assert that we would like people to receive hydration and nutrition, but not when it is burdensome for them?

Jim Dobbin: I have made that point a number of times, and I am grateful to my hon. Friend for reiterating it.

Mr. Duncan Smith: I support new clauses 1 and 2. The hon. Member for Heywood and Middleton (Jim Dobbin) has set out a strong, factual case as to why the Government should support our proposal. I shall concentrate on only one thing, because there is a tendency to overcomplicate the issue. This group of amendments is at the heart of our debate today and we should consider whether or not, at the end of it all, we should withdraw food or fluids from people who would otherwise live. That is the critical point. The problem
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with the Bill is that it would give powerful legal backing to a certain interpretation of living wills. By the way, many Members may not know that a living will does not have to be a written document, and could result from a general conversation while watching a television programme which, like one shown in the United States, graphically depicts what happens to people who are in pain later in life. Someone might say to someone else, "Look, you are going to be my advocate. I do not want to be kept alive unnecessarily, and I do not want medical intervention to keep me alive." When the individual is incapacitated, their advocate can say that they made it clear that they did not want any medical intervention. However, the individual concerned would not have said that they wanted food and water, the most natural form of treatment, to be withheld. That is at the heart of our proposals which, as the hon. Member for Heywood and Middleton said, do not aim to overturn the Bland judgment.

To make my position clear, I think that the Bland judgment was wrong. I have tabled amendments proposing that Parliament should make such decisions and not leave them to the courts. Why, after all, are we elected to the House if not to represent the interests of our constituents and make these decisions on their behalf, having discussed the matter with them? However, I am prepared to compromise, and I support new clauses 1 and 2, which will not reverse the Bland judgment, much as I would have liked them to do so. They make it clear that we should find in favour of life—that is the critical issue. Some people have asked for a definition of "burdensome". At the moment, however, the priorities are the other way round, and under the Bill it would be easy to withdraw food and fluids from an individual.

Doctors and nurses in other parts of the world often disagree with the advocate's judgment. Some of them say that they can communicate with the individual, but their arguments have failed in court. That is the problem with the Bill, which removes the opportunity to reconsider what happens to a loved one. If the person concerned is conscious, even briefly, it prevents them from making a final judgment. That is the key issue. Many hon. Members on both sides of the House will agree that the hon. Member for Crosby (Mrs. Curtis-Thomas) spoke movingly about her experience when her mother died. If they have not already done so, I recommend that they read her speech, which makes it clear that we should make a judgment in favour of life. If we persistently confuse medical treatment with administering food and water, we will find against life.

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