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Mr. Clarke: That is all the more reason why what the Minister has to say becomes profoundly important. I look forward to it.
I will now make the brief speech that I wanted to make at this point. In most of the debates, including Second Reading, I concentrated my remarks on the parts of the Bill that dealt with advocacy. I hope to have the chance to speak on that aspect later. That did not mean that I was not interested in the end-of-life issues. I am profoundly involved in all the discussions that are taking place, especially in my constituency, where I have received many representations and people are anxious to hear what we decide today.
The fact that I did not take part in most of those discussions in Committee did not mean that that was the position in Coatbridge and Chryston. I want to summarise what my constituents feel and what they expect from today's debate. It could become extremely complex. Indeed, very often in Committee, it did. We had opinion and counter-opinion, but I supported Second Reading in order to give the Government the opportunity to clarify where they stood.
I regret to say that I left Committee thinking that this was unfinished business on two crucial issues. That is why I am attracted to new clauses 1 and 2. I found very acceptable the views of my hon. Friend the Member for Heywood and Middleton (Jim Dobbin) and of the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith). Although we could make the matter complex, it seems to me, having listened to hours and hours of debate, that there are two issues that need to be resolved, two issues that call for clarity and two issues that do not seem to me to be intellectually demanding.
On the issue of food and liquid—hydration and nutrition—have we made it clear that our priority is in respect of treatment and not of life? Have we made it clear that we are on the side of the patient until the end of his or her natural life? As this is all about perception, I want the medical profession to know where it stands. I do not want to see court case after court case. The obligation is on us to offer that clarity. That is one of two important issues on which simplicity invites itself. It is
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whether hydration and nutrition can be withdrawn legally—something that all of us, because we have said that we are opposed to euthanasia, do not want to see. We are entitled to an answer to that question. I am afraid that we did not get it during the whole process of consideration in Committee.
The second point was raised at great length in Committee and in the Second Reading speech of my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas). What is the mechanism for taking on board the view of someone who, at an early stage in their life makes a written will, gives their instructions, signs an advance directive or gives some indication that they want to do so and later changes their mind? Those were the two crucial end-of-life issues, and they have not been resolved.
Mr. Edward Leigh (Gainsborough) (Con): The right hon. Gentleman is making a clear and cogent speech. The debate has been over-complicated, and he is trying to set matters right. Is there not a third point that has to be articulated strongly? It is surely the point of new clauses 1 and 2. The decision of proxies or the existence of the advance should not override the clinical judgment of a doctor, which at that stage may well be to preserve life and provide treatment.
Mr. Clarke: If I were to follow what the hon. Gentleman says, I think that I would make things even more complicated. I have no desire to do that because I am trying to stick to the simple issues that have emerged after long discussions and on which I have received many representations from my constituents.
I plead with my hon. Friend the Minister to offer much more clarity on the two issues that I have raised than has been the case so far. Incidentally, I do not agree with my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman) because I think that Ministers acted before the Committee with great courtesy. Clearly, however, they are carrying out whatever Government directive has been given to them, although I know that they will take on board the strong views expressed by hon. Members on both sides of the House.
The scrutiny of the Joint Committee has helped our considerations. The Committee was headed by Lord Carter, who is a fine person, and was made up of Members of the Lords and Commons. On the Committee's advice, a clause to exclude euthanasia was included in the Bill. I accept that, but why then are people including representatives of the Church of England and the Catholic Church—until we receive an explanation about the archbishop's letter—still pressing for the clarification that I am seeking? I suggest that it is because they think that they have not received answers to the two simple questions that I posed. I also suggest that they rightly have it in mind that the Bill deals with a special group of people. All individuals in the group have a right to life, but nevertheless experience limited capacity. For that reason, they are entitled to even more protection from the House in our legislation than might otherwise be the case, and I hope that we will decide to give them that following today's deliberations.
Mr. Robert Key (Salisbury) (Con):
At the beginning and the end of human life, science, medicine and technology are rapidly pushing out the boundaries of
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the possible. Humanity moves on, as must we, but we must decide where to draw the line on behalf of the people of this country. Only last week I met a constituent in the House of Commons who had been in a coma for a year following a vehicle accident. His parents had been asked whether they agreed to the withdrawal of his hydration and nutrition. They said no, and five years later that young man is running his own business in Salisbury.
Fortunately death is no longer a taboo in this country, and we have heard moving personal testimonies to that today. Our personal experiences always colour the way in which we think about such matters and no doubt the way we vote. I am no exception to that. I recall having to make a life-and-death decision about my baby son while my wife was under sedation—that was one of the loneliest decisions I ever had to make, although I am confident that I made the right one. Many of us have seen our parents dying, and I saw my dear sister-in-law dying from motor neurone disease, so I have my own opinions, just as I have my own faith to cope with that. However, what about the views of others? We must all have been influenced by the views of charities, the Making Decisions Alliance and other people and organisations who have been in touch with us.
I shall vote to give the Bill its Third Reading, but first, on behalf of my constituents, I want to try even at this late stage to improve it. We in Salisbury are fortunate to have the Salisbury hospice care trust, which is made up of a group of dedicated professionals and clinicians who are held in the warmest esteem throughout our community. Indeed, I think that they are part of our extended family in Salisbury. I held conversations only this morning with several retired professionals who had worked in palliative care. I also asked a practising sister on the ward and a consultant in palliative care for their views this morning. Perhaps the views of such people have not been heard to a great extent—they have certainly not been heard so far in this debate. The doctor said that advance directives were helpful because, as he put it, they help professionals to know what makes a patient tick. Forward care planning is seen as a good thing from a clinical point of view because it opens up lines of communication that would otherwise not exist. However, there is great concern about the validity of advance directives that were made 20 or 30—or even five—years previously. We need solutions to the problems that patients will face as they come closer to death.
2.45 pm
Andy Burnham (Leigh) (Lab): The hon. Gentleman mentions patients making choices as they get closer to death. Does he accept that in some cases, albeit not all, a powerful survival instinct takes over meaning that patients can display amazing powers of recovery of which they might not have been able to conceive? Does that not emphasise the purpose behind the amendment tabled by my hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth): when possible, the presumption should be in favour of saving life?
Mr. Key: I entirely agree that the presumption must be in favour of life.
As the clinical staff put it to me, they face the problem of "demedicalising" end-of-life care when they know that they can do nothing further. Once again, they are
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taking a new view as medical technology moves on—it is doing so rapidly. I have never spoken to anyone in the hospice movement who is in favour of euthanasia, but it is a sign of the times that end-of-life care is changing in the way in which the Bill represents.
I have been greatly moved by what my constituents have said. I was pleased that Church of England bishops, in addition to the Roman Catholic Church, expressed concerns in the past year or so. Church of England bishops tell us that difficulties remain with withholding and withdrawing assisted feeding and hydration. They have been in touch with many hon. Members about amending the Bill by including a presumption in favour of continuing life-sustaining treatment, yet not requiring such treatment in inappropriate circumstances. As the Bishop of St. Albans said in a letter to The Times this morning:
"If such clarifications can be put in place we would conclude that the Bill's safeguards in this area are probably satisfactory."
It is important for us to realise, as the bishop says, that the
There has not been a great deal of disagreement in the debate thus far. I believe passionately that the House of Commons is the place in which such debates should be held. On beginning-of-life issues, we know about the tangle into which the Human Fertilisation and Embryology Authority has got because it is has been asked to do too much within the framework of existing legislation, which has meant that the Government have had to review it. We do not need bioethics committees, but debates of this calibre in the House, with the one difference that all hon. Members should have a free vote.
I shall support new clauses 1 and 2 because it is important to probe the Government to find out whether they are prepared to go the extra mile. If they win the vote, I have no doubt that the matter will be reopened in another place. The Bill is important and I am quite sure that it should receive its Third Reading after 15 years of debate in the country. However, we do not yet have the assurances that we require to be completely confident about it, so we look to the Minister to give us such confidence this afternoon.
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