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Mr. George Howarth (Knowsley, North and Sefton, East) (Lab): I wish to speak to amendment No. 2, which is in my name and that of the hon. Member for Tiverton and Honiton (Mrs. Browning), and new clause 4, which is in my name and that of several of my hon. Friends.

Amendment No. 2 represents a genuine effort to build a consensus, which we hope addresses the key objectives that must be addressed if we are to resolve the issue. From the debate so far, I have a clear sense of what the House does not wish to condone in respect of patients who are in a coma or are otherwise incapacitated and unable to make a realistic or meaningful decision, who may be inappropriately subjected to invasive procedures to sustain or hydrate them in the last hours of their lives. Furthermore, I do not believe that we should in any way undermine the principle of advance directives, on which there is also some consensus, in terms of the circumstances in which those directives might be taken seriously. In that regard, the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) made an interesting point about a conversation held while sitting watching the television, but advance directives and the intent behind them should be judged more seriously than that.

Mr. Duncan Smith: With respect to the hon. Gentleman, I notice that new clause 4 says:

In our new clauses, we define palliative care as including food and fluids. Is that included in his definition?

Mr. Howarth: I will talk about new clause 4 in a moment, and try to explain the point about which the right hon. Gentleman has asked me. I want to develop the argument in a logical way.

Mrs. Curtis-Thomas: My hon. Friend has expressed some reservation about the way in which advance directives are articulated. This morning, I spoke to a consultant from the Netherlands, who talked about the Dutch rules and regulations on euthanasia. He said categorically that there would be no moves to euthanise a body without express written consent that indicates that the individual has been made fully aware of the consequences of the decisions that they are about to make. Would he be keen to see a move made that would formally require advance directives to be written rather than verbally communicated?

Mr. Howarth: My hon. Friend will forgive me if I do not address that point at this stage. I have tabled new clause 4, I will speak to it, and I will listen with interest to what my hon. Friend the Minister says in response. My approach to this matter will become apparent, I hope, during the course of my speech. My hon. Friend almost certainly will not agree with me by the end of it, but she will at least see where I am coming from.

I do not want people without capacity to be unnecessarily deprived of sustenance or liquids. Most of us do not want people to be unreasonably subjected to invasive procedures in the last hours of their lives. Moreover, there is the issue of advance directives.
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Mrs. Browning: In the context of people in the last hours of their lives, it is not just what the Bill does in terms of their wishes that is the issue, but how the medical profession will interpret the Bill in terms of possible litigation against them, if it is not interpreted in the way that they see it as drafted. The worry is about getting the balance right between sustaining fluid and nutrition until the point at which someone does not naturally take it, and then having invasive procedures. Under those circumstances, nobody would ever die peacefully at home.

1.15 pm

Mr. Howarth: I thank the hon. Lady for that intervention. Just as the right hon. Member for Chingford and Woodford Green was inspired by my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas), it was a speech made by the hon. Member for Tiverton and Honiton (Mrs. Browning) in Standing Committee that set me off along this track. I will address exactly her point in a few moments.

Many of the views expressed already in the debate reflect people's decency and straightforwardness in terms of how they wish to interpret the Bill. To be fair and honest, it is not reasonable to say that those qualities exist on one side of the argument but not on the other. Everybody is struggling to find a way through these difficult issues. In the course of trying to arrive at a form of words that makes some kind of sense, I sat through almost all of the Standing Committee, and consulted the British Medical Association and as many of the faiths groups as I could—some chose not to respond, for whatever reason—and I feel that there is a genuine wish in the House and elsewhere to arrive at a decent, straightforward conclusion that reflects in the best way possible the many circumstances in which the provisions will have to be applied.

Mr. Frank Field: Does my hon. Friend accept that many of us could vote for his new clause but also for the others? He is dealing with an immensely important area that strengthens the role of the doctor. He will know that one of our most distinguished doctors, Professor Tallis, has written that he has undertaken treatment when he believed that he should not do so, because, like all other doctors, he was scared of what the relatives would do to him in the courts. The new clause strengthens the hand of doctors in saying that treatment is not right at such a stage, and it is therefore fair for some of us to support him in the Lobby on his new clause while also voting for the other new clauses that are down for discussion.

Mr. Howarth: I have known my right hon. Friend for many years and have found that the best course of action with him is not to provide him with any advice, as he has his own opinions and arrives at them in his own way. I am confident that he has the intellectual capacity to work out his own position. What I would say, however, is that there is some merit in his argument. Earlier, we both took part in a Merseyside radio programme—we were not on the same programme simultaneously, but I had the benefit of hearing his contribution—and he made that point then. The climate is difficult, and we live in what people have referred to as a compensation culture. His concern is genuine and I am
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sure that, if a distinguished medical practitioner says that it is a problem, we must take it seriously. I hope that my hon. Friend the Minister will address that point when he speaks later in the debate.

Mr. Andy Reed (Loughborough) (Lab/Co-op): On consensus, it is clear that most people in the House would not want any form of euthanasia. For people such as me, who feel strongly about that, there is a certain amount of confusion at this stage about exactly what is being proposed. Having listened to my hon. Friend's contribution so far, I am looking forward to hearing more of it. I also have a great deal of sympathy with what the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) said, following our discussion earlier this morning. As my hon. Friend makes progress in his speech, will he enlighten us as to what he believes are the deficiencies of new clauses 1 and 2, and how his new clause would make the position much clearer, as many of us are genuinely struggling with this issue even at this late stage, despite the thousands of briefings that we have received from all parts of the country?

Mr. Howarth: What my hon. Friend says reflects the anxieties of many Members on both sides of the House. I do not suggest that this should be the final word, but I think it relevant to remind Members of the wording of clause 58, entitled "Scope of the Act". It says

Mr. David Drew (Stroud) (Lab/Co-op): Will my hon. Friend give way?

Mr. Howarth: I will, if my hon. Friend will allow me to go on replying to my hon. Friend the Member for Loughborough (Mr. Reed) first.

Both the right hon. Member for Chingford and Woodford Green and my hon. Friend the Member for Heywood and Middleton (Jim Dobbin) pointed out that the debate on euthanasia was a separate debate, although some Members might prefer it not to be. A Bill on the subject is currently before the House of Lords. To avoid any doubt, however, my hon. Friend the Minister chose to include clause 58, and I consider that helpful.

Mr. Drew rose—

Sir Gerald Kaufman rose—

Mr. Howarth: I did say that I would give way to my hon. Friend the Member for Stroud (Mr. Drew). I will give way to my right hon. Friend after that.

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