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Mr. Lammy: Conversations continue, and of course I will be saying that.
Mr. Burstow: I hope that the Minister will make it clear that the intention is to find a further amendment that will address this concern.
Mrs. Browning:
I want to have a go at trying to persuade the hon. Gentleman to vote for amendment
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No. 2, which deals with the principle of the matter. The Bill talks about many ways in which life can end, and it is always difficult to address such matters adequately, but the principle behind amendment No. 2 is that it is in a person's best interest for life to continue. That may be for only a short while, or in circumstances in which invasive treatment cannot be considered, but surely the principle that life must continue must be placed on the face of the Bill. If not, the Bill will be specifically about ending life, and it should not be about that.
Mr. Burstow: No, it should not. I am still uneasy about the interaction between the drafting of amendment No. 2 and the new clause. The danger is that the Bill may be tilted towards asking whether a person's life has worth and so is worth saving. A better question is, "Is this treatment worthwhile and beneficial?" My amendment would try to change the presumption.
Mr. George Howarth: Will the hon. Gentleman give way?
Mr. Burstow: The hon. Gentleman said earlier that many hon. Members wish to speak, and I do want to make some progress, but I will let him intervene.
Mr. Howarth: I am grateful to the hon. Gentleman for giving way, but I think that he is misrepresenting amendment No. 2. The presumption in the amendment is not that it is the quality of a person's life that should be judged. It is simply that it is better for a life to continue than not to continue. Questions of quality have to do with what is appropriate in the period between a decision being made and the end of that person's life. As the hon. Member for Tiverton and Honiton (Mrs. Browning) said, that will vary in every case.
Mr. Burstow: My anxiety is made worse by the fact that an amendment proposed to amendment No. 2 would delete the word "best", and water down the original in other ways. I accept that that is not the hon. Gentleman's doing, but that is the proposition before us today, and it gives rise to further concern.
The amendments that I support are about clarity and reassurance. They are about ensuring that we are focused on treatment that is beneficial, not burdensome. We must make it clear that the courts still have jurisdiction in such decisions. Those amendments will be the subject of a free vote, but amendment No. 46 is about ensuring that regardless of whether someone retains capacity, he or she is treated in an equal fashion and is not the subject of prejudice, or bogus assumptions that lead to inappropriate treatment. That is the key to amendment No. 46 and I look forward to the Minister's response to it.
2 pm
Dr. Iddon:
I speak in support of amendment No. 32, in my name and that of other right hon. and hon. Members. The amendment has the clear aim of removing advance directives, or living wills, from the Bill. I should say at the start that I do not belong to any pro-life organisations and I do not practise any religion actively, so I am not under any pressure from that direction. I am disappointed that we can have a free vote
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on beginning-of-life issues, but not on end-of-life issues. I would have preferred it if Labour Members had a free vote on this issue.
I remind the Government that 102 Members of Parliament have signed early-day motion 336, which recognises that there is a problem with this Bill. I cannot vote for advance directives—sometimes ironically called living wills—to become part of our statute law, because they have always been abhorrent to me. However, to those who believe in them, I say that I have no objection to people making living wills provided that they remain in common law and are not enshrined in this Bill.
I shall explain why I cannot vote to include advance directives in the Bill. First, we had a considerable debate on living wills when similar legislation passed through the Scottish Parliament. That resulted in the Adults with Incapacity (Scotland) Act 2000. The debate there resulted in similar clauses to those we are discussing being removed from the Scottish legislation. That is a significant point that we should remember. Secondly, the House of Lords Select Committee on Medical Ethics recommended in 1994 that advance directives should never be legally binding, as is proposed this afternoon. In paragraph 264 of its report, the Committee stated:
"We suggest that it could well be impossible to give Advanced Directives in general greater legal force without depriving patients of the benefit of the doctor's professional expertise and of new treatments and procedures which may become available since the Advanced Directive was signed."
The rest of the report contained similar comments.
Thirdly, there is the uncertainty cast on advance directives by the recent challenge to them by Leslie Burke of Lancaster. The General Medical Council has appealed that decision and Parliament is awaiting the result, but it is pertinent to the decision that we will take this afternoon. Leslie Burke made the point that advance directives are very negative. One can ask the doctor not to do things, but one cannot ask the doctor to do things. That is the challenge by Leslie Burke and it is pertinent to our vote today. I cannot vote for advance directives when I do not know the result of that appeal.
Fourthly and significantly, the 23rd report of Session 2003–04 from the Joint House of Commons and House of Lords Committee on Human Rights, published as recently as 29 November, casts serious doubts on the Government's assertion that the Bill is compatible with human rights legislation. The Joint Committee believes that the Bill raises serious human rights concerns, which include putting advance directives in the Bill. It was not that long ago that the Government were against including advance directives in statute law. Why have the Government done a U-turn on that?
I accept the good intentions of the Government in introducing the Bill that has had a long gestation—about 15 years, in fact—and I am only sorry that the Bill has been spoiled by the failure to listen to its opponents. I am very disappointed that it came out of Committee unamended. Not a single principal amendment was accepted in the course of a fairly long Committee stage, and that concerns me.
My fifth point is my real message: it is not what is in the Bill that counts, nor even what is left out of the Bill, but the signal that the Bill sends. I shall explain that by
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reminding the House of the origins of advance directives. They were launched in the United States of America in 1969 in a law journal article entitled,"Due Process of Euthanasia: The Living Will, a Proposal". That is the paper from which the subject of our debate arose. In 1977, a US health department official, Robert Derzon, advised President Carter to
"The cost-saving from a nation-wide push toward Living Wills is likely to be enormous. Over one fifth of Medicare expenditures are for persons in the last year of their life".
In 1991, the US Government made it compulsory for all patients admitted to a hospital, for whatever reason, to be presented with living will forms to complete. We might argue that that could never happen here. Well, it just has. In 2003, the Hammersmith Hospitals NHS Trust decided that it would offer living wills to all those admitted. It was followed by Imperial college hospital. Will that bandwagon roll further? Will the Government allow the NHS to give everyone admitted to hospital a living will? If someone is given a living will on entry to hospital, it puts them under pressure at a time when they are already sick and possibly depressed. What a time to give people a living will—as they are admitted to hospital. I condemn Hammersmith Hospitals NHS Trust and Imperial college hospital for that.
Mrs. Browning: Given that the Bill is about people who lack capacity and would be unable, therefore, to fill in such a living will, should a relative be able to fill in the form for them?
Dr. Iddon: I do not know what Hammersmith Hospitals NHS Trust has in mind. I do not know the details of its agreement. However, I would be worried about it whether or not a relative filled it in. I am against the principle, which comes from the US.
Is it any wonder that some of us link the Bill to euthanasia? In fact, the Voluntary Euthanasia Society and other organisations appear to be behind the move to enshrine advance directives in the Bill. If they are successful this afternoon, they will get a signal that the bandwagon is beginning to roll. There have been three attempts, including this one, by people such as Lord Joffe, to bring assisted suicide or voluntary euthanasia before Parliament. This Bill sends out the signal that the Government might—I emphasise the word "might"—be willing to listen to those people at some time in the future.
Let us be fair to the Voluntary Euthanasia Society—it is, after all, one of the main propagators of living wills: its path is clear and if we do not know that, or cannot understand it, we should. Its path is to bring assisted suicide, or voluntary euthanasia, to this country, as has happened in the Netherlands, Belgium, Oregon and elsewhere. I am against that.
The bioethicists march on. In a leading article, published in 1997 in the "Hastings Center Report", one of the pre-eminent journals on bioethics, Professor John Hardwig argued that there was a duty to die and published criteria to help people make that decision. I am horrified that in the Daily Mail this week, Baroness Warnock told the elderly something similar, under the headline, "Kill yourself, so you won't be a burden". That is reprehensible stuff. Where is the country going?
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People can change their mind. My hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) gave us an example when she talked of her mother. The respected journalist Claire Rayner signed a living will. Unfortunately, she had to go into intensive care where doctors could twice have switched off her life, but her relatives were not happy about it. I do not think that the doctors were happy either, but at the time living wills came under common law—not statute law. She survived and the first thing she did when she came out of hospital was to tear up her living will.
At a conference in Holland in 1990, right to die groups pushed a pamphlet on living wills; on the back was the heading, "The Living Will: Passport to Euthanasia". If Members do not believe that people who push living wills will not be pushing assisted suicide or voluntary euthanasia next, they are living in cloud cuckoo land. That is why I am so against enshrining living wills in the Bill, and that is why I shall vote against it today, good as other parts of it are.
At a meeting of the education council of the Euthanasia Society of America, a new document was proposed, whose stated purpose was to provoke a gradual change—a gradual change—in public attitudes to euthanasia. The author of the document also made a link between living wills and euthanasia. That is why some of us—perhaps only a minority—link the application of living wills under the Bill to euthanasia by omission, if not by commission. People who sign advance directives are usually convinced that they are taking greater control of their life, whereas in fact they may be giving up control of their life. That is one of the dangers.
The concept behind an advance directive must surely be that the patient be allowed to die with dignity and in the absence of pain, yet by refusing some medical treatments the patient could suffer a lengthy, painful and bedridden existence, simply because they wanted doctors to carry out an advance directive.
I am also concerned about the pressure that such provisions would put on the health service. The Minister wants people to obtain advice from their doctors, but are not general practitioners already hard pressed? How would such provisions operate in a hospital, especially in an accident and emergency department? How much bureaucracy will they pile on the NHS? If living wills are accepted in the Bill, more people will think, "They're a good thing, I'll make one, too." Relatives will start to talk. The whole process will gain momentum—the very thing the Voluntary Euthanasia Society wants. The more of them that are written, the more bureaucracy will be piled on the NHS. That is another reason why I am against enshrining advance directives in the Bill.
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