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Mr. Patrick Hall (Bedford) (Lab): Does my hon. Friend agree that there is no euthanasia under English law, only murder, and there is no way under English law that a person can ask someone else to murder them?

Dr. Iddon: That is true, but I am talking about euthanasia by omission, which would be the danger under the Bill, and about which many of us are worried.
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Mr. Duncan Smith: May I, through the hon. Gentleman, answer the question put by the hon. Member for Bedford (Mr. Hall)? If one withdraws food and water from someone, one brings about their death. That may not be termed murder, but it is exactly the same thing.

2.15 pm

Dr. Iddon: I do not want to comment on that point of view. I respect the right hon. Gentleman's opinion.

I am concerned that we are developing negative attitudes in our health care and social care systems. We hear about the burden of care and we talk about the quality of life as though people who have a poor quality of life should no longer live. Those are negative attitudes. We should rejoice that people have had a good life and help them to die in dignity. We should promote palliative care and hospices. We should fund children's hospices properly. That is the direction that Parliament should take, rather than the negativity of some parts of the Bill.

Mr. Lammy: Does my hon. Friend agree that there are currently three positions on this matter? He makes a strong and impassioned case for altogether abandoning living wills and advance decisions. Under common law, people can seek to make living wills. People with Alzheimer's want to be able to say, "This is what I want to happen to me when my mental faculties go completely"—which is why the society supports the provision—and that is what they tell their loved ones. We either abandon living wills altogether, as my hon. Friend says, or we seek to make them safer and stronger so that the clinicians who have to apply them can do so in the right circumstances. In essence, that is the situation that we are debating.

Dr. Iddon: I never said that we should abandon living wills altogether. People have a right to make them, if only to flag up their wishes to their relatives—if not to their doctors—but I do not want to enshrine them in the Bill and send a signal to the Voluntary Euthanasia Society that it is winning the argument. That is the point I was trying to make.

Mr. Lammy: If we leave living wills as they are, they remain unregulated, unsupervised and unchecked. Doctors tell us that they do not know where they are.

Dr. Iddon: As I have tried to explain, if we accept the provisions in the Bill, more people will think that living wills are a good thing. I have already explained the consequences of that so I shall not go over that ground.

Other Members want to speak, so I shall finish by reading out a statement that was referred to on Second Reading, but it is worth repeating. The pro-euthanasia bioethicist Dr. Helga Kuhse said:

I do not want to take even the first step on the path that the Voluntary Euthanasia Society wants us to tread, and that is why I shall vote against the inclusion of living wills in the Bill. I hope, Mr. Deputy Speaker, that you will put amendment No. 32 to the vote.
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Ann Winterton: I support new clauses 1 and 2. Neither has been proposed because we, on our side of the argument, are vitalists who seek to preserve life at all costs. It is right that we must limit medical care where it will not work, where it is futile or burdensome, and that is done regularly in clinical practice. However, that is a different matter entirely from requiring, as the Bill would in certain circumstances, that treatment and/or assisted food and fluids be withheld or withdrawn from non-dying patients. The question should always be: is this treatment worth while? It should not be: is this patient's life worth while? That is why I cannot support amendment No. 2, tabled by the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth).

I want to speak, as briefly as I can, on best interests in relation to amendment No. 1, because the Bill pivots around the definition of best interests. All acts done or decisions made under the Bill for or on behalf of a person who lacks capacity will be required to be done or made in his best interests, but the Bill's explanation of best interests makes no reference to the fact that persons, even when unconscious of or mistaken about their interests, have an objective interest in their own life, health and well-being. Instead, it says:

The Government have tabled an amendment to clause 4 that would introduce a slightly greater element of objectivity, but I do not believe that that amendment is sufficient.

The Bill goes on to say that, "in particular", there must be consideration of a range of factors, all of which relate to predicted capacity or incapacity, participation in decision making,

and the views of interested persons on

just mentioned. Those matters to be considered "in particular" all relate, as can be seen, to subjective interests—desires, wishes, beliefs and values—not to the real dignity and value of the person's existence: life, health, and well-being as such. What is to prevent or even discourage those making such determinations from determining that it is in a patient's best interests not to receive treatment, that it is in the patient's interest to die because "That is what they would have wanted"? How many times have we heard that—even when a reasonable medical judgment would show that treatment would be neither futile nor unduly burdensome, but beneficial?

The Government say that medical professionals will continue to use the traditional concept of best interests, which includes the patient's interest in life and health as central elements of his or her real welfare, but is it reasonable to suppose that professional attitudes will not be affected by the subjective character of the Bill's approach to best interests? I remind the House that the ethics of the medical profession, as has been rigorously documented and demonstrated, were rapidly and profoundly affected for the worse by the Abortion Act 1967. I do not think that anyone could disagree with that statement.
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Does the word "circumstances" securely imply a reference to the person's intrinsic interest in health and life? Will the medical insurers whose advice affects professional thinking regard it as safe for medical professionals to think in terms of medical best interests when proxies appointed under clauses 9 or 16 have made determinations relying on non-medical, subjective criteria? Is it not highly significant that those proxy decision makers will not be subject to the professional responsibilities and ethics that the Government presume will continue to apply to medical professionals? Is it even clear whether the new offence of ill treatment or neglect by a proxy will include improper determination of a patient's best interests, or refusing treatment on the basis of such an improper determination? How many doctors will have the time, energy and motivation to ask a court to override a proxy whose determination of best interests appears to them defective or questionable?

Mr. Julian Brazier (Canterbury) (Con): I am most grateful to my hon. Friend for giving way in her powerful speech. Did she see the testimony in The Times only a week or two ago that related to a case where the doctors were continually pressed by the relatives who constantly visited a lady of 59, to give her more and more pain killers to a clinically dangerous degree? Only when she turned 60 and the relatives ceased to turn up, did the doctors discover that they had a life assurance policy to be paid if she died before she was 60.

Ann Winterton: I did not see that story, but it is horrific, and I am grateful to my hon. Friend for drawing it to the attention of the House. I had a letter from one of my local hospices to say that the only time that its staff have been pressed to end a patient's life more quickly than it would have ended naturally, or ended through the double effect, was when the relatives would have benefited from the patient's will.

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