Withdrawal of Medical Treatment (Hansard, 23 March 1994)

§ Mr. Gary Waller (Keighley)
I beg to move, That leave be given to bring in a Bill to prescribe circumstances in which medical treatment and nutrition can be withdrawn and to secure the continued provision in such circumstances of palliative care; and for connected purposes. The Bill concerns an extremely sensitive subject, relating as it does to the last great unmentionable—the end which confronts all mankind.
I am sure that the House will join me in congratulating those in another place who recently produced an outstanding report on the complex issue of medical ethics. There is a great deal of good sense in its recommendations, not least in its unanimous rejection of euthanasia, and I hope that it will point the way ahead for many years to come.
I seek to provide the House with an opportunity to reaffirm its opposition to the practice of euthanasia—the intentional killing of a patient by act or omission as part of his or her medical treatment. That practice is, and must remain, illegal. Most of the evidence received by the House of Lords Select Committee on Medical Ethics rejected the practice of euthanasia. The British Medical Association and the Royal College of Nursing, the National Hospice Council and, indeed, other health care organisations all gave evidence to that effect.
The Medical Ethics Select Committee recognised that the medical, legal and social arguments against euthanasia were particularly strong. Medically, it recognised that advances in palliative care had enabled the pain and distress of terminal illness to be relieved in the vast majority of cases. Legally, it recognised that the prohibition of intentional killing is the cornerstone of the law and social relationships and that that protection must not be diminished in any way. Socially, it recognised that, while there may be individual cases where some may consider euthanasia appropriate, the interests of the individual cannot be separated from those of society.
To legalise euthanasia would result in the vulnerable, the elderly, the lonely, the sick or the distressed feeling pressure—whether real or imagined—to request an early death.
In the face of those arguments, there is a minority who think that euthanasia should be legalised. The Voluntary Euthanasia Society continues mischievously to claim that 79 per cent. of people in this country are in favour of euthanasia, basing that claim on an opinion poll that it commissioned. However, an investigation by the Select Committee revealed that it asked the question: Would you like medical assistance to a peaceful death? Few would respond in the negative to such a loaded question.
Recently in a public debate, a leading member of the VES stated that many doctors in the United Kingdom are in favour of euthanasia. In reality, at its last conference, the BMA voted four to one against the legalisation of the practice.
We need to clarify the difficult issues involved in the withdrawal of medical treatment. Decisions about medical treatment and the end of life are more complicated now than they have been in the past. As a result of advances in medical technology, patients live longer and can survive conditions that in the past would have meant a swift end. 285 While those advances are welcome, they sometimes make it necessary to consider whether initiating a course of treatment will benefit or be a burden to the patient.
The decision can be made more easily in some cases than in others. Where a patient is competent, the decision may be arrived at through discussion between the patient, the relatives and the health care team. I stress that the autonomy of the patient is crucial and if a patient does not want to persist with an aggressive form of treatment, that decision should be respected and treatment withheld or withdrawn. That is good medical practice. It has long been accepted that a doctor does not have to strive officiously to maintain life. The prolongation of life is not the exclusive aim of medical practice, and as the founder of the present-day hospice movement, Dame Cicely Saunders, put it: doctors are committed to giving appropriate care to their patients, not to every treatment that may be technically possible". With regard to incompetent patients, or where a patient is confused or unconscious, decisions about treatment withdrawal can be much more complex, for it is difficult to know what such patients' wishes are in the current situation. Advance directives can be helpful in providing guidance about the treatment of such patients, but we should not forget that not all possible situations can be foreseen. No doctor in this country should ever have to face possible legal action because he or she did not, or could not, follow an advance directive to the letter. Such action has taken place in the United States.
If there is no indication of a patient's wishes, decisions must rest with the health care team and the family of the patient. They have to decide whether the treatment to be given is appropriate. That entails an analysis of whether the benefits of treatment will outweigh the burden of the medical procedures.
The House of Lords Select Committee addressed the issue in relation to the case of my constituent Tony Bland, who was tragically left in a vegetative state following the Hillsborough disaster. The Select Committee rightly stated in paragraph 257 of its report: it might well have been decided long before application was made to the court that treatment with antibiotics was inappropriate, given that recovery from the inevitable complications of infection could add nothing to his well-being as a person. In short, it would have been perfectly ethical for Tony Bland to be allowed to die long before he did, had the health care professionals involved in his case been advised differently. I take this opportunity to pay my tribute to Tony Bland's parents and to all those people who cared for him towards the end of his life.
The House of Lords Select Committee was divided on one issue: the difficult one of nutrition and hydration. In my view, however, food and water are such vital necessities that their withdrawal from a patient who is not in a terminal state can be intended to have only one outcome—killing that patient. They should only be withdrawn, therefore, from a patient who is approaching death and where their administration would be burdensome. I stress that the report of the Select Committee pointed out that the appropriate handling of a case at an earlier stage would mean that the sort of dilemma that the courts considered last year need never arise.
Thirdly, I endorse the Select Committee's call for the provision of greater resources for palliative care, of the 286 type provided by the hospice movement to the terminally ill. With almost 200 centres for palliative care in the United Kingdom and with provision for the dissemination of care in hospitals and in the community, so much has been achieved in recent years. In my constituency, the Sue Ryder Manorlands hospice and Ardenlea, which is run by the Marie Curie Memorial Foundation, are two of many whose dedicated work is so highly regarded by Members of Parliament.
Additionally, the Select Committee suggested that research into pain relief and symptom control should be more fully supported. I understand that the Government will soon reply to its report and I hope that there will be a positive response to that and to other valuable suggestions.
The demand for palliative care is such that it should be made more widely available. It need not disturb us if, as a secondary effect of such care, the life of the patient may be shortened. That is the so-called principle of double effect, which was supported and upheld by the Select Committee. If the doctor intends to relieve pain and the treatment given is appropriate to that end, the possible double effect should not be an obstacle to such treatment.
I hope that all those people who are interested in such issues will note and heed the warnings from developments overseas. The British Medical Journal reported last month that the Dutch Attorney-General had ruled that a psychiatrist who helped a physically fit, but depressed 50-year-old woman to commit suicide should not be prosecuted. There is also overwhelming evidence that involuntary euthanasia has become widespread. Such cases show that Holland presents a model of how a slippery slope may become ever steeper.
By supporting the Bill, the House will echo the great majority of the medical profession who oppose euthanasia. The House will support them in the difficult decisions that they must often take not to persist with medical treatment that would be of no benefit to their terminally ill patients. It will also give renewed confidence to the hospices and palliative care teams who see euthanasia as a negation, in every way, of the ethos that underpins their commitment and inspires their work. Our message today should be clear and it must be unmistakable: with the right sort of care, life can be lived to the full to the very end.

§ Mr. Tony Banks (Newham, North-West)
I wish to oppose the ten-minute Bill motion of the hon. Member for Keighley (Mr. Waller). I have great regard for the hon. Gentleman, but the way in which the Bill has been introduced is ill-conceived.
I support the concept of euthanasia, not because I am oblivious to the significance of human life, but because, if the hon. Member for Keighley were successful and got the Bill on the statute book, it would further restrict the right of an individual to choose. Everyone has the right to maximum dignity in life and indeed, in death. Through his Bill, the hon. Gentleman seeks to endorse the main themes of the Select Committee on Medical Ethics in another place, as he said. By opposing euthanasia in its report, that Committee attacked the rights of those people who wish to leave this life with dignity.
Seneca wrote: If I can choose between a death of torture and one that is simple and easy, why should I not select the latter? As I choose the ship in which I sail and the house which I inhabit, so will I 287 choose the death by which I leave life. Historians will no doubt recall that Seneca was forced to commit suicide.

§ Mr. Derek Enright (Hemsworth)
Absolutely.

§ Mr. Banks
I knew that there would be at least one historian in the House who would remember that.
Those who support euthanasia stress the voluntary nature of the act. It is not compulsory. Nothing in this life is simple and the same is true in death. I accept that multiple moral considerations are involved; doctors and close relatives can find themselves facing terrible dilemmas. However, the right of an individual to choose must arch across those difficulties.
The hon. Member for Keighley mentioned the withdrawal of medical treatment. The medical profession makes considerable use of what may be described as passive euthanasia. A doctor can exercise many decisions—such as not resuscitating a patient after a heart attack, not administering antibiotics to treat pneumonia or other infections mentioned by the hon. Gentleman, and not inserting artificial feeding tubes through the nose or direct into the stomach. All are examples of passive euthanasia, and they are extensively discussed by the medical profession—if only because advances in medical science allow doctors to prolong the dying process.
Compassionate doctors are often caught between the suffering of their patients and their duty, as they see it, to prolong life. If a doctor does not treat a life-threatening condition in an already sick patient, the doctor makes the choice on the patient's behalf. I see that as a form of medical paternalism—the Idea that doctor always knows best. The British Medical Association clearly states that the power to decide rests with patients. A report in the British Medical Journal in December 1991 deplored the lack of guidelines for non-resuscitation orders in hospitals. Regrettably, in far too many cases the wishes of the patient are never even sought, never mind taken into consideration.
Under British law, competent adults have the right to refuse any or all medical treatment. That right is often invoked by people who want to die with dignity, at a time of their own choosing.
The hon. Member for Keighley spoke of a patient becoming incompetent or unconscious of what is happening, or being unable to communicate clearly. In such a situation, doctors cannot know a patient's wishes. Would they welcome a non-treatment decision or the intrusive and sometimes violent treatment necessary to sustain life?
The hon. Gentleman touched on, but moved quickly away from, the usefulness of advance directives—or living wills, as they are known. Right hon. and hon. Members will no doubt be delighted to know that it is not my intention to pop my clogs just yet, but my wife and I have signed living wills because we believe them to be important. The individual merely states on the advance directive the sort of life-prolonging treatment that he or she does not want if they suffer in future from an incurable disease causing unbearable suffering.
A directive also provides for the event of a brain-damaging accident requiring life support systems to 288 maintain a vegetative patient, and the option to have one's life terminated. A directive does not ask a doctor to do anything illegal, such as actively terminate life, but only requests that artificial, aggressive or extraordinary means —all medical terms—are not used to prolong the dying process.
In 1992, the BMA gave full support to advance directives, stating that patients' wishes must not be overridden and that doctors must not impose their own views of beneficial treatment on others.
The legal status of an advance directive has never been tested in a British court, although statements made in the Court of Appeal and by Law Lords in the Tony Bland case indicated that an advance directive is binding. The hon. Member for Keighley said that Tony Bland could have been allowed to die earlier if the correct advice had been given, but that was not the situation. Tony Bland's parents were forced to go through the whole process of the law to do, as caring parents, what was in their son's best interests. Despite the obstacles that they met, their noble stand was supported by the majority of the people of this country. If Tony Bland had signed an advance directive, his parents would have been spared all that grief and heartbreak.
In the United States of America, Germany, Netherlands, Denmark and some Australian states, living wills are fully recognised. Also, a number of countries recognise durable powers of attorney in health matters—something that this country should recognise.
The hon. Gentleman placed great emphasis on the ability of palliative hospice care in keeping patients free from pain. We all acknowledge that hospices do wonderful work, but it is not true that palliative care removes all pain and distress in all patients. I know that is so because my father died of cancer. I do not see a contradiction between offering palliative hospice care and making voluntary euthanasia an option. They should both be included in the range of options available at the end of life. Apart from the unfortunate minority who cannot be kept comfortable, many people simply do not want the slow way of dying that hospices offer.
I have great feeling and warmth for the hon. Member for Keighley, but because I believe that euthanasia is a right —the right to live one's life in dignity and to leave one's life in dignity, I must oppose his motion.