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Ann Winterton (Congleton) (Con): Will the hon. Gentleman give way?

Mr. Howarth: Yes, but this really must be the last time.
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Ann Winterton: I am very grateful to the hon. Gentleman, who has made great efforts to simplify this issue. My only criticism of his amendment is that it asks the House to judge whether a person's life is worth while or otherwise; in my view, the issue should be not that, but treatment. He cites the BMA in respect of basic care, but he has not dealt with the issue, raised by my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith), of withdrawal of hydration and nutrition in palliative care. We call such care basic care. Does the hon. Gentleman agree, and does he believe that it should not be withdrawn from a person who is not dying?

Mr. Howarth: In the overwhelming majority of cases, the point made by the hon. Lady and the right hon. Member for Chingford and Woodford Green will apply, but as I have said, every case is unique. As the Minister made clear in an intervention, in some circumstances and in respect of some conditions, hydration and sustenance, far from helping, would actually make matters worse. I do not want to leave scope for any misinterpretation in that regard. Basic care is one thing; hydration and sustenance is another. In the overwhelming majority of cases, they will be the same thing, but in some circumstances they might not be. I want to make it clear that even in cases where hydration is inappropriate, it is not appropriate to leave somebody with a dry mouth, for example. That would be very uncomfortable for them, and it would make the dignity and comfort of their last hours worse, rather than better. Let the House be in no doubt about that.

I and my hon. Friends the Members for Ealing, North (Mr. Pound) and for Dartford (Dr. Stoate) have tabled new clause 4, which deals with new clause 2 in simple terms; in fact, it consists solely of the first line of new clause 2 and eliminates the subsequent elaboration. I do not know what the Minister's response to it will be, but it is a genuine effort to retain the sentiment behind clause 4 without allowing it to be read as a set of instructions in every circumstance, which would be a mistake. That is the intention behind our provision, and if the Minister can satisfy me on this point I will be very happy indeed.

If there is a flaw in amendment No. 2, as the Government amendment to it implies, I stand ready to correct it and I will listen very carefully to the Minister's explanation as to why his amendment is necessary.That apart, I believe that my amendment strikes the right balance. It accepts that sustenance and liquid will normally be made available, but by stating the principle in simple terms, it allows for cases where doing so is undesirable and not in the patient's best interests. To put it starkly, I believe that it avoids setting up a practice that too often leads, albeit unintentionally, to people being attached to tubes or subjected to other invasive procedures to no useful purpose, with all the attendant discomfort and indignity caused to people in their final hours.

I commend the amendment to the House. Subject to what the Minister says, I hope that we can form a consensus around its principles and make the legislation better.

Mr. Paul Burstow (Sutton and Cheam) (LD): I rise to speak primarily in support of my amendment No. 46, but also in support of the amendments and new clauses
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proposed by the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth). I shall also speak to support the proposals tabled by the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) that I have also signed.

I want to make it clear from the outset that I do not believe that the Bill gives the green light to euthanasia. That is not just my view, but that of the Catholic bishops conference, which said in its briefing to the Bill on Second Reading:

That is an important and clear statement. Some of the press comments on the Bill seem light years away from the measured tone of the Catholic bishops. Some of the reporting over the last few days has been ill informed, misleading and, in going out of its way to frighten people, arguably mischievous. That is a real cause of concern.

The Bill is about giving people who lack capacity greater control over their day-to-day lives.

Mr. McNamara rose—

Mr. Burstow: If the hon. Gentleman has a question about the Catholic bishops, I am more than happy to take his intervention now.

Mr. McNamara: I am most grateful. The hon. Gentleman cited what the Catholic bishops said. However, they also said that although clause 58 could not be correctly described as introducing a permission for euthanasia, which would have meant opposition for that reason, it still had two serious and remediable weaknesses. They said that, unless the weaknesses were addressed, the Bill could still unintentionally become a vehicle for euthanasia by omission or withdrawal of medical treatment.

Mr. Burstow: The hon. Gentleman is right. That is why, in Committee, I tabled an amendment that was not dissimilar to the new clauses before the House today. It posed the question of the central purpose behind the action. Is it to hasten a person's death or is it to palliate and provide care, comfort and support? That is central to today's debate and I am clear in my personal view that the new clauses provide the additional reassurance that both the Church of England and the Catholic bishops conference are seeking from the House today. That is why I started my remarks by observing that they have been assured on certain points, but the hon. Gentleman is quite right to draw attention to the fact that some further matters remain before the House today.

As I was saying, the Bill is about giving people who lack capacity more control over the way they live their day-to-day lives. Understandably, our debate is focusing on end-of-life decision making, but the bulk of the Bill is about the millions of people in this country who lack capacity to take decisions and it provides a proper framework in which they can take more
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decisions and exert more control over their own lives. It is about decisions as simple as what people eat, what they wear, when they go out and when they go to bed; everyday decisions that we in the House and many of our fellow citizens take for granted.

The central purpose of the Bill is to maximise the opportunities for people to take such decisions for themselves. It enshrines in law a new starting point—a presumption of capacity—and only when it is proven that capacity is lacking can someone else start to take proxy decisions. Those outside the House who want to portray the Bill as somehow having an evil intention are doing a disservice to millions of our fellow citizens who will benefit from it. That, as well as the concerns of the Catholic bishops and others, needs to be put on the record.

That does not mean that certain issues do not remain to be debated at this stage of the Bill or that the new clauses and amendments in the group would not help to further strengthen the safeguards. Indeed, the Bill will be strengthened considerably if they are passed today. I do not mean to imply that no further safeguards are needed in respect of such matters as advance decision making. I believe that, as a general rule, they should be put in writing, but that is sadly not the case in the Bill as it stands at the moment.

1.45 pm

I want to make it clear that Liberal Democrat Members have a free vote on new clauses 1, 2 and 4 and on amendments Nos. 1 and 2. I will personally support new clauses 1 and 2 and will deal in a moment with my reasons for doing so. The hon. Member for Knowsley, North and Sefton, East is right that people on all sides of the debate are trying to strike a balance and to find a way through and make it absolutely clear that the Bill is not about euthanasia. The best way of striking that balance is by testing opinion through free votes in the House. I regret the unwillingness in certain quarters to allow free votes on this matter. It reflects a weakness in the argument, but I appreciate that it is not the hon. Gentleman's fault.

I want to speak to amendment No. 46. I believe that people have the right to expect that they will be cared for to the highest standards. The purpose of my amendment is to introduce an equal consideration clause into the statement of principles in the Bill. Such a clause would ensure that a person who lacks capacity is treated no less favourably than a person—any other person—who either lacks capacity or has capacity in similar circumstances. The purpose is to make it clear that proxy decision makers must banish their personal prejudices and attitudes when they come to act on behalf of a person who lacks capacity.

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