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Lord Turnberg: My Lords, as I understand the amendments tabled by the noble Baroness, Lady Knight, they are designed to ensure that doctors and others can object, because of their conscience, to proceeding with this process. We all want provision to be made for conscience objection; the question is whether it needs to be included in the Bill in this form or whether it exists elsewhere.

That leads us to the very legal discussion of whether or not sufficient protection already exists for those with a conscientious objection—unfortunately, I am not a lawyer. Until today, I believed that there was. As
 
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I understand this Bill and other legislation, there is protection. If that is the case, we certainly do not need this provision.

To reassure a consultant who may resign is not a good reason for including a provision in the Bill, if he could be reassured by another means. I look forward very much to the Minister's explanation of exactly what protection already exists. I believe that it does exist.

Baroness Finlay of Llandaff: My Lords, I apologise to the House that I was abroad during the previous stages, but I am glad to be here. I have been reading Hansard while I have been away.

The sentiment behind the amendment is very clear. I feel strongly that people must be able to exercise their conscience. However, I am concerned about the wording of the amendment, partly because I am not sure what would happen to other patients if somebody simply exercised their conscience under the amendment and walked away.

To clarify the position I telephoned the head of the human resources department in my own trust, Velindre NHS Trust. He was most helpful and took advice more widely in a short time. In a way, it was useful, as it mirrors the clinical situation where he is put on the spot and must come up with an answer quickly. He was quite clear that if a member of the clinical team, at whatever level, had a justified conscientious objection—not a frivolous one—and did not feel that they could go along with a decision, they certainly were protected and could not be forced to act. It would be against the human rights of that employee if they felt forced to act.

However, the head of human resources also pointed out that it is appropriate that the employee should be required to help locate somebody else; otherwise, they could walk out of the hospital and leave other patients' lives in jeopardy. It would be appropriate for them to try to find somebody with whom to swap in order to help whoever was leading the team. I tried to work through a clinical example. I could envisage a situation where one might even defer a decision by a few hours until a different team of nurses, secretarial or porter staff came on duty. That would enable the individual employee to exercise their conscience while the specified decision of the patient and/or of their next of kin—or their attorney, if they have made such provision—can be gone through with, and those in the clinical team who agree with the decision can proceed without harming the individual employee. I found that a most helpful conversation.

It is also worth remembering a point that was made in helpful correspondence I received from the Minister on advance decisions; that is, the phrase that if you are not satisfied it is valid, you do not have to exercise it. That leaves a lot more to the conscience of the individual clinician in the interpretation of that decision. In other words, if you are going to go along with a decision, you must be satisfied that it is valid. If you have doubt—the Minister's speeches that I have read in Hansard have been clear—you must default to life-preserving, life-prolonging treatments.
 
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I believe that it is for those reasons that the noble Baroness, Lady Knight, has brought forward an amendment with the best of intentions. However, I am slightly concerned that not only is it unnecessary, but that it might also inadvertently harm the care of other patients by allowing someone to walk away from the clinical scenario.

Lord Christopher: My Lords, I apologise for being late—in particular to the noble Baroness, Lady Knight, who has been very kind to me recently. I realised that I had not paid my lunch bill and I did not want to leave the House for a week in debt.

It is very difficult to argue with what the noble Lord, Lord Patten, said, but I am extremely grateful to the noble Baroness, Lady Finlay, for confirming what was in my mind. I do not quarrel with the thought that conscience may become more of an issue as years go by. There are all sorts of reasons why that is so and it begs the very important question of how it should be dealt with in Parliament. Should it be dealt with in legislation or in some other way?

My common sense told me, which the noble Baroness, Lady Finlay, confirmed, that if a doctor or a nurse has a serious conscientious problem over what he or she is asked to do, it would be an extraordinary organisation that did not somehow meet that problem, which I think has been confirmed. In a sensible organisation one does not want to have an argument. Indeed, that happens on occasion with our Whips when we say, "I am terribly sorry. In conscience, I cannot oppose a Liberal Democrat amendment". It is not a difficulty that arises frequently but it can arise. Therefore, it is far better to consider alternative ways to deal with the problem.

I shall conclude with an anecdote, because something that the noble Lord, Lord Patten, said rang a bell with me. Here we are in the very last knockings, perhaps, of legislation in this Parliament. My anecdote goes back to 1976 when I was on the Civil Service council that dealt with pay and we had what I thought was a good offer. We were arguing. Some of my colleagues were saying that it was not enough, "No" and so forth.

Off the top of my head, I said, "Do you realise that here we are havering around and that any minute we may hear that the Prime Minister has resigned"? There was a knock at the door and a secretary walked in with a note to give to the chair. It said, "The Prime Minister has just resigned". We never got that pay award.

There is a serious risk, if we are not careful throughout the rest of this day, that we may lose all the good that is in this Bill. I hope that no noble Lord, except in the most extreme circumstances, which I do not see on the Marshalled List, is prepared to push this to the brink, because we may throw the baby out with the bath water.

Baroness Masham of Ilton: My Lords, I have added my name to these amendments. We are discussing a very serious matter. What is more important than life and death? With our multinational and multiracial society we
 
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need clarity on the freedom of people's consciences. The debate on these amendments shows how different people interpret so many things in different ways. We need clarity. I support the amendments.

3.15 p.m.

Baroness Greengross: My Lords, on thinking very carefully about the amendment put forward by the noble Baroness, Lady Knight, and her colleagues, in total sincerity, we are in danger of forgetting that the Bill is to protect primarily the patient. We are getting into a situation where the patient's needs would become secondary to the needs of the people caring for them.

Baroness Ashton of Upholland: My Lords, perhaps I may begin by saying to the noble Baroness, Lady Knight, that I absolutely agree that no one should be pressurised into doing anything against his or her personal values and beliefs. But I still stand by what I said at previous stages of the Bill. The noble Baroness, I trust, will accept that at each stage of the Bill I go back and look at what we have said and make sure that the advice and evidence that I receive is accurate. I have, indeed, ensured that in this case it is right.

As I explained to the noble Baroness and to the House at Report stage, health professionals already have the right to conscientious objection. But, of course, they have to arrange for the patient's care to be transferred to a suitable practitioner and, of course, make sure that the patient does not suffer. That would be inappropriate, and I am sure that they would not wish to do that.

On Report, the noble Lord, Lord Alton, and the noble Baroness were right to give examples of individuals. At that point, I made the offer that if they gave me the information, I would ensure that those individual cases were examined. I hope that they will do that, for nothing has been forthcoming since we had those discussions. If they are of such an important nature, as the noble Lord particularly felt, I am willing to make sure that they are followed up. I hope that he will bring them to my attention.

Lord Alton of Liverpool: My Lords, perhaps the noble Baroness will recall—it is in Hansard—that a record of each of the cases was in the debate last week. But I am very happy to meet her officials to give the identities of the people that I mentioned.


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