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Mr. Lammy: Does the right hon. Gentleman accept that people can make a living will under common law, and that the Bill provides the safeguards that doctors have been calling for when making those advanced decisions? Does he accept that that is why Age Concern, Help the Aged and the Alzheimer's Society have asked for such legislation?

Mr. Duncan Smith: With respect, we have been through that many times. People are not against the principle of clarifying the position on living wills. However, new clause 1 deals with the problem that food and fluids are deemed to be medical treatment by the
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courts. Someone who specifies the withdrawal of medical treatment or tells someone else that that is what they want is unlikely to mean that they wish to be starved or dehydrated to death. That is the problem at the heart of the bill.

1 pm

Claire Ward (Watford) (Lab): I am listening carefully to what the right hon. Gentleman is saying. He makes the point that he does not agree with the Bland judgment. I agree with it, although, at the other end of the scale, I do not agree, under any circumstances, with euthanasia. He is essentially arguing against Bland, which makes things difficult as it is confusing the issue surrounding new clause 1. I find that extremely difficult, since he does not agree with the Bland judgment, yet he is arguing the case for new clause 1.

Mr. Duncan Smith: The hon. Lady says that she does not agree with euthanasia, but what is being done to someone in terms of bringing about their death when food and fluids are withdrawn? I do not understand this ludicrous debate—dancing on the head of a pin—about what happens to somebody: if I stop someone eating and drinking, they will die and I would be assisting them to die. That, in essence, is euthanasia.

I have said all along that I do not necessarily agree with how the Bland judgment has classified food and water as medical treatment, but I am prepared to accept that we should not overturn it through the Bill. I am saying that the declaratory position would change the emphasis and move the question to whether a treatment is worth while, which is what we should be asking, rather than whether a patient's life is worth while, as will be the case under the Bill. That is a fundamental difference, that is what the new clauses would do and that is what I am prepared to accept.

Mr. Frank Field: Does the right hon. Gentleman accept that we are not discussing the Bland judgment? That comes later, but it is important to make that clear. My hon. Friend the Minister has trotted out Age Concern and all those other great organisations, but how many of their representatives have living wills? The vast majority of our constituents do not have living wills in any form, written or unwritten.

In considering the Bill, we are dealing with those who are incapable of making a judgment. What should the legal framework be to protect their interest? That is the judgment we have to make, but not for those of us who have decided that we want to go out of this world in a certain way. There is a case for debating that issue in respect of living wills and for honestly debating euthanasia, but there is no case for having euthanasia by the back door—withdrawing food and liquids from people when we are professing to do something else.

Mr. Duncan Smith: I agree: that is where we are and what I began with in speaking in support of the new clause. I genuinely cannot understand why any Member of the House would not support the new clause, because as has just been made clear and as I made clear earlier, this does not deal with the Bland judgment. It would
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make it clear, should these issues go to court, that the favour rests on whether a treatment is worth while. That is what the two new clauses address and I do not consider this such a radical move. It would be a fair decision that took into consideration concerns that the Minister raised in Committee, I gather, and on Second Reading. It would do no Member any harm to vote for the new clause, because it would help to reshape the Bill with regard to the issues that all those charities referred to.

I accept it from the Minister that there are many who want the Bill. I have said that a large chunk of it is welcome, but this area leaves it very open to challenge.

Mr. Hilton Dawson (Lancaster and Wyre) (Lab): Can the right hon. Gentleman assure me that his new clauses are so well drafted that they would not allow circumstances in which someone moving inevitably towards a dignified and peaceful death was disturbed by unnecessary and uncomfortable medical treatment?

Mr. Duncan Smith: I can give the hon. Gentleman the assurance of a non-lawyer and of someone who, I hope, comes to the House with a certain amount of common sense. These new clauses were drafted so that that could not happen. If the Government think that areas of the new clauses would cause a problem, please come forward and help us to redraft them. Let us do that right now and vote on them, but they will not do that, as they seem almost scared stiff of any amendment to the Bill. We heard from the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), who said that Members of the House were all promised that amendments would be tabled. No such serious amendments have been tabled. The reason is that the Government do not want this area to be dealt with at all.

I simply say to hon. and right hon. Members in all parts of the House that we have in front of us today a very serious question: do we make a presumption for life or a presumption that, in some circumstances an individual may have their life ended, and assisted to be ended, by doctors and others who might be against such a presumption for life?

Mr. Lammy: The right hon. Gentleman frames his contribution around the advance decision as it pertains to new clause 1. Does he accept that the advance decision is exceptional in the Bill, as most of it concerns best interests? In dealing with the individual's right when he has capacity to say, "One day, when I no longer have capacity, I do not want this kind of treatment," we are not dealing with best interests in that regard. Also, quite rightly, we say at clause 25(5) that the person should be specific when life-sustaining treatment is involved. That is an important hurdle and something that we should all take seriously.

Mr. Duncan Smith: So presumably, the Minister is going to move an amendment that will result in all these living wills being written down and legally checked. Is he going to move such an amendment right now? No, although I will give way to him if he wants to tell me that that is the case. He knows very well that he will not, so let us not have this stupid and silly game in the House. The fact is that he knows that had he said to many of his
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colleagues that this would be written down and regularly checked, there might have been a reasonable debate on this matter.

I do not know why the Government are playing this game. Someone might have said such a thing to another person five or six years previously, but are we presuming that they never thought about it again and that their mind did not change over that period? Of course not. The Minister knows very well that, as the hon. Member for Crosby said, people change their minds. We know that most people who attempt suicide do not want to die. That is the reality. Many such people have said it subsequently—they changed their mind. The Bill does not allow for that, which is the key issue.

Mr. Lammy: We had that debate on Second Reading. Suicide notes are ruled out. A suicide note could never, ever be an advance decision. The right hon. Gentleman makes an important point about the written statement. If the Government were to give such an undertaking, would he vote with us today?

Sir Gerald Kaufman (Manchester, Gorton) (Lab) rose—

Mr. Duncan Smith: I give way to the right hon. Gentleman.

Sir Gerald Kaufman: May I suggest that if that is the calibre of the Minister's interventions today, he would do better to remain seated? May I make this point to the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), which has been illustrated by my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas)? It is one thing for a person to signify an advance wish when they are articulate, but a time may come when they are no longer articulate although their mental activity is as strong as it was and they want to change their mind. The Bill before the House slams the door on that change of mind.

Mr. Duncan Smith: That is exactly right and it is my main reason for supporting the new clauses. I say to the Minister, with respect to him, that it is a bit late in the day to come here and play this game, "If I say that I might say this, would you say something else?" I thought that, in government, the object is to lay one's position on the table so that we can all decide whether we agree.

The Minister has had plenty of time to come to the House with specific amendments to allow us to vote on what is in his mind, not on what he might do. He has time—if he wants to do that, let him do it—but I am not going to play this game, "If you do one thing, I might do the other."

I feel passionately about this issue, which is not party political, and I have been inspired by speeches made from the Labour Benches and by actions of many of the Minister's colleagues who are opposed to this proposal. I simply say to them all that this is a chance for Members of the House, once and for all, to represent our constituents and to do something that perhaps the courts do not do—take genuine consideration of real people who suffer and worry about such events. People who are not necessarily members of the judiciary or
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legally qualified—that is us—can do something with a bit of passion and heart. We can put some heart and soul into a soulless Bill. We should vote for these new clauses.

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