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House of Lords

Thursday, 3rd July 1997.

The House met at three of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Lichfield

Lord Leconfield and Egremont--Took the Oath.


Lord Rowallan asked Her Majesty's Government:

    Whether, as reported in the recent programme "Frontline Scotland" (broadcast on 25th March 1997, repeated on BBC2 on 17th June 1997), it is possible for people who have no relevant qualifications to set themselves up as paramedics and attend major sporting and other events; and, if so, whether they propose to take any action to remedy this.

The Parliamentary Under-Secretary of State, Scottish Office (Lord Sewel): My Lords, it is the responsibility of event organisers to make sure that staff they expect to attend to injured or ill people are appropriately qualified. They should seek advice from local health boards or from the Health and Safety Executive.

Although we have no current proposals for compulsory registration of paramedics at present, our minds are not closed and the issue will be kept under active consideration.

Lord Rowallan: My Lords, I thank the Minister for that reply. I am concerned that along the length and breadth of the country organisations which have even been employed by the Crown Office have people who purport to be paramedics. As was shown in the two programmes, those people can cause great hurt and damage to persons who believe that they are receiving the best of treatment. Are the Government aware that the BMA has passed a motion that the title "paramedic" should be legally protected and urges the Government to take the necessary legislative steps to ensure that that occurs?

Lord Sewel: My Lords, I appreciate the noble Lord's concern on this matter. The issue seems to have mushroomed recently. Clearly government and ministerial colleagues in general would wish to give considerable consideration to the views of the BMA. However, at this moment I cannot give an undertaking that we shall come forward with definite proposals. It is a matter that we shall wish to consider. I shall take back to them the noble Lord's message from the BMA.

Lord Howell: My Lords, in view of the reopening of the Hillsborough inquiry into an event in which there were many unfortunate deaths and injuries, will my

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noble friend consider asking Lord Justice Stuart-Smith if he will kindly consider the ancillary matter of properly trained people at sporting occasions?

Lord Sewel: My Lords, the point raised is more general than the specific matters to be dealt with under the Hillsborough inquiry. We would wish to come forward with a general proposition affecting the whole country rather than basing it on a specific inquiry.

The Earl of Lindsay: My Lords, how widespread does the Minister believe the problem to be? At what point would the Minister be prepared to do something about it?

Lord Sewel: My Lords, I am aware that it is a growing problem; I am not sure of its dimensions. At this stage I pay tribute to the considerable work undertaken by the Red Cross, the Saint Andrew's Ambulance Association, and the St. John Ambulance Association and Brigade in attending sporting events. I seriously urge all those connected with organising sporting events to make sure that they take the proper advice and seek the assistance of reputable organisations.

Lord Swinfen: My Lords, the Minister's first Answer struck me as being extremely complacent. Do the Government appreciate that people who are not properly qualified who set themselves up as paramedics can be extremely dangerous to those who are injured or ill?

Lord Sewel: My Lords, the difficulty is that the profession of paramedics is relatively new. I do not think that anyone is yet certain about the appropriate qualification for a paramedic. Considerable progress has still to be made on that issue.

Terminally Ill Patients: Medication

3.11 p.m.

Lord Ashley of Stoke asked Her Majesty's Government:

    Whether they will clarify and explain the law regarding the administration of drugs to relieve the pain and distress suffered by terminally ill patients.

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, the Government recognise that this is an extremely difficult ethical and legal question. With the forgiveness of the House, I shall answer the Question in a little more detail than I would normally hope to do. We are very sensitive to the needs of people who are terminally ill and to the concerns of their families. We recognise that there are differing views about the range of responses that should be available in some cases. Wherever possible, patients should have a choice of treatments and care. However, the law does not permit euthanasia but recognises that sometimes the level of medication required to control the overall symptoms may shorten the patient's life. Provided that the primary intention in administering the

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medication is the relief of pain and suffering and not the deliberate shortening of the patient's life, then this is lawful. In forming a judgment about treatment, the doctor will assess the overall symptom control, the views of the patient if those are known, any relevant advance refusal of treatment, and, of course, the best interests of the patient.

We have no plans to legalise euthanasia but will follow very carefully developments relating to the care of terminally ill people as well as the strong public debate that surrounds these very difficult issues.

Lord Ashley of Stoke: My Lords, I warmly appreciate that comprehensive and very specific reply. Is my noble friend aware of the assessment by Dr. Finlay, a professor of palliative medicine, that up to 30,000 cancer patients die each year in unnecessary distress as a result of the reluctance of their doctors to use morphine? That is indefensible. Will the Government consider changing the law so that, instead of doctors being permitted to prescribe drugs of their own free will for terminally ill patients who are in intolerable pain, they are required to do so if that is the wish of the patient?

Baroness Jay of Paddington: My Lords, it is worth reminding my noble friend that the development of palliative care has done much to change our attitude to death and the process of dying, teaching health professionals that death is not a failure. With appropriate palliative care, pain can be greatly reduced and people can be helped to cope with it. We are committed to expanding palliative care for the dying in all settings, not merely in the hospice movement. It is our policy that all patients needing these services should have access to them and we are seeking to encourage their provision throughout the NHS. As my noble friend will be aware, if an advance directive about the withdrawal of treatment is given by a patient and is accepted as being valid at a time when that treatment is under question, then it will be accepted by the medical profession.

The Duke of Norfolk: My Lords, are the Government aware that within the hospice movement people can die without pain? My wife is intimately concerned with this. For those who enter a hospice, with the administration of drugs, there is no pain at all. Hospitals are not quite so up-to-date in this matter. Secondly, are the Government aware that in my faith, which is the Christian faith, and in the Jewish, Mohammedan and no doubt other faiths--to all those of us who believe in religion--the idea of euthanasia is totally repugnant?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Duke for reminding us of the extraordinarily good work done by the hospice movement and by all of those involved with palliative care. The NHS and the Government will continue to work very closely with the movement. In fact, I have had a very successful personal meeting with the executive director, Mrs. Gaffin, within the past few

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weeks. I accept that those who are fortunate enough to have that kind of care have a great deal of pain eased. As the noble Duke said, it may even cease. Unfortunately, that is not the experience of everyone facing terminal illness. It is that difficulty that we seek to address.

Viscount Tonypandy: My Lords, is the Minister aware that the country is in very great debt to Professor Finlay. At a hospice in Cardiff it has been proved that people can die without pain. However, if patients believe that a doctor has the right to make up his mind rather than theirs, then there will be fear. Does the Minister agree that those who suffer terminal illness above all want to make up their own mind and not have it made up for them by anyone else?

Baroness Jay of Paddington: My Lords, I welcome the noble Viscount's comments. I am very happy to see him in his place making a contribution to this important debate. The points he makes are exactly those about the ability of people to control their own lives and to understand the treatment they are given. That is why there is a role for the advance directive whereby people can, if possible, say how they would like to be treated at a later stage in their life.

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