§ Mr. Nicholas Winterton (Macclesfield)
I have initiated this timely debate because I fear that two fundamental principles are being undermined, which the House must take the earliest opportunity to reinforce.
First, the House is surely the guardian of the rights of the individual citizen. It is the protector of the vulnerable, of the weak and of those who are unable to speak for themselves. It is here and nowhere else that laws upholding that principle should be decided.
Secondly, since the time of Hippocrates, patients have been able to look to their doctors to uphold the highest ethical standards; to do all within their power to protect the patient's health and well-being and never to take steps either of commission or of omission to harm patients, let alone intentionally to bring about their death.
The two basic principles that I have outlined are now under threat. I believe that the primacy of this place is being challenged and that the special relationship between doctor and patient, and the wider contract between individuals and society as a whole, is in desperate jeopardy. The threat to both principles is posed by the co-ordinated thrust being made to bring about the decriminalisation of euthanasia.
It is clear from the attendance in the Chamber that many hon. Members on both sides and in all parties share what I can describe only as my profound concern about recent developments. I have no doubt that many of them will seek to take this opportunity to put on record the reasons for their concern.
I am especially delighted to see in her place the Chairman of the Select Committee on Health, my hon. Friend the Member for Broxbourne (Mrs. Roe). I am also delighted to see that a long-serving member of the House, my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), is in her place. Also present is another long-serving member of the Select Committee and its predecessor Committees, the hon. Member for Belfast, South (Rev. Martin Smyth). The hon. Gentleman has served with me on the Select Committee and its predecessor Committees for many years. I see also in his place a Member who led the Select Committee on Social Services with great distinction, the hon. Member for Birkenhead (Mr. Field). I know that he feels as strongly as I do on this subject.
I shall take the opportunity to explain why I and, I believe, the overwhelming majority of those who have considered these issues carefully, have reached the inescapable conclusion that the decriminalisation of euthanasia is as unnecessary as it is unethical and repugnant.
§ Mr. Harry Greenway (Ealing, North)
Is the thrust of my hon. Friend's argument that euthanasia is, in the end, the killing of people? That is against God's law. I recognise how hard it must be at times for individuals to deal with these matters, but we must all die in God's time, not in man's time. Does my hon. Friend agree?
§ Mr. Winterton
I entirely agree with my hon. Friend's views. Euthanasia is against God's law and against the law of the United Kingdom. The law says that it is wrong intentionally to kill a person. I fully support my hon. Friend's views.
151 The Law Commission recently produced a report on mental incapacity, which dealt with the issues that I have raised. It is being considered by an interdepartmental working party established by the Lord Chancellor. Earlier this month the British Medical Association published a document entitled "Advance Statements about Medical Treatment". In my view, parts of that document do not reflect the views of the majority of doctors. If those parts are taken with the sections of the Law Commission's report which call for legally binding living wills, the door to euthanasia could be opened wide.
§ Mr. Peter Luff (Worcester)
Is my hon. Friend aware that his contention that the majority of doctors may not support the BMA's recent document is borne out by a letter that I received from two doctors at the Worcester Royal Infirmary Trust, who expressed strong reservations about the BMA's recent document? They told me that, at a meeting on 10 April, those reservations were widely shared. The two doctors are concerned about the attempt to introduce euthanasia through the back door without the sanction of Parliament.
I can only say that the views expressed to my hon. Friend by doctors in his constituency reflect the views expressed to me by doctors in my constituency and elsewhere. It is worth mentioning that the working party set up by the BMA, which has produced rules and guidelines, does not, I believe, represent the policy of the BMA as a whole. It is also worth noting that only five of the 16 members of the steering committee or working party are doctors. The steering committee was composed mainly of lawyers and, dare I say it, ethical advisers.
It is time that the House pointed out a few basic and inescapable facts to that small, unrepresentative and essentially unaccountable clique of lawyers and doctors and reminded them that any move towards euthanasia has been made redundant by our world-leading pioneering of the hospice movement, with which I am proud to be involved in my capacity as a vice-president of the East Cheshire hospice in Macclesfield, which my hon. Friend the Member for Congleton (Mrs. Winterton)—I am delighted to note that she has just taken her place—and I jointly opened in the presence of the Lord Bishop of Chester, Michael Baughen. Any move towards euthanasia has also been made redundant by tremendous developments in palliative medicine, and great strides in geriatric services.
§ Dame Elaine Kellett-Bowman (Lancaster)
Does my hon. Friend agree that we should take a lesson from what has happened in Holland? If we take one step down this road, there is no stopping the rush to euthanasia. We must be warned by Holland's example.
§ Mr. Winterton
The House should note carefully what my hon. Friend has said. She is a long-serving Member. I intend to take up the example of the Netherlands. We must be careful before any decisions are taken to move down the path to any form of euthanasia.
I remind those doctors and lawyers and their allies in the Voluntary Euthanasia Society that the prohibition of intentional killing is the very cornerstone of our civilised society and of our law. The role of the doctor is to cure and, if that is not possible, to care for his patients. To permit doctors intentionally to kill would be a dramatic 152 change which I believe—I think that my views are widely shared—would discredit the medical profession and undermine the fabric of our society.
No one is saying that the medical profession should strive at all costs, even officiously, to keep alive patients who are dying. Nor is anyone saying that drugs such as painkillers should not be prescribed if one of their side effects is to hasten death, provided that the doctor's motive is pain relief and not the death of the patient.
Those are delicate and difficult issues, which the BMA and the Law Commission have failed fully to understand and on which in their reports they have badly let down not only their own professional, medical and legal communities but society as a whole. If euthanasia were to be decriminalised, the elderly, the infirm and the chronically. sick would immediately be under both real and perceived pressure to request it to end what is portrayed as the burden that they place on the shoulders of relatives and society as a whole.
What starts as voluntary euthanasia would rapidly become encouraged euthanasia, which would then become pressurised euthanasia and then, inevitably, compulsory euthanasia. I will hear no calls in the House today of "death with dignity" or of a "blessed relief from an existence of unbearable pain." Outstanding advances in symptom control and pain relief enable hospice doctors and others to relieve pain in the overwhelming majority of cases.
What the disorientated elderly require is love. How often is that word used in the Chamber? They want compassion. They want understanding. They want support. They do not want death. What the incurable cancer sufferer needs is nursing care, pain relief and, what is more, emotional relief and help with an uncertain but approaching death, and the impact that it will have on loved ones. What the AIDS victim needs is medical care, nursing care, psychological care, and to spend the last of his or her days in the warmth of Christian compassion. What all those groups and many more require is not the indignity of death at the hands of their doctors, but the knowledge that, until the moment of their natural death, they remain valued members of society—loved, cared for and respected for their inherent individual worth.
The heroes and heroines who care for the incurably ill, the psychogeriatric and the severely handicapped in our society today, are legion. We all know that fact as Members of Parliament. They are too numerous to list, but they include all those involved in the hospice movement, those who provide hospice care at home, the Macmillan nurses, the members of the British Geriatric Association, which has been so supportive of what I am seeking to achieve today, and the tens of thousands of doctors and nurses who daily dedicate their lives to care, in their commitment to those who are suffering from terminal or aging illnesses. I put a rhetorical question to the House: does the commitment of those professional caring people count for nothing? Are we to go down the path to mercy killing, as it has come to be known?
It might be helpful if I remind the House that parliamentary concern on these matters led to the establishment in another place of a Select Committee on Medical Ethics to consider the very matters that we are debating today. The appointment of Lord Walton to the chairmanship of that Committee—an individual who was already openly associated with campaigns to promote euthanasia—as well as other members, such as Baroness
153 Warnock, who were already publicly on record as supporters of euthanasia, did little to inspire confidence in the Committee's impartiality. Indeed, the majority of its members were believed to be supporters of a liberalising of the law in this area.
Yet, after 12 months of hearing expert evidence, and deliberating carefully on these important issues—the Committee had undertaken one of the most thorough and well-researched reports on euthanasia that this country had ever seen—and despite the preconceived ideas of many of its members, I am pleased to tell the House that its report was unanimous in its rejection of euthanasia. I commend it to hon. Members as essential reading for those who would understand these sensitive and difficult issues.
Something must also be said at this stage about the Voluntary Euthanasia Society and the irresponsible and, dare I say it, devious manner in which it has presented and propagated its views. Naturally, as a Member of the House, I would champion the right of the VES and its supporters to air their views, even though personally I fundamentally disagree with them, but it is worth highlighting the fact that the VES regularly quotes a national opinion poll in which it claims that 79 per cent. of people in this country support voluntary euthanasia. If it is not an unparliamentary word—I hope that it is not—I would reject that claim as twaddle, and observe that the claim was heavily criticised by the House of Lords Select Committee and later by an editorial in The Lancet as thoroughly misleading. The question asked was:Would you like medical assistance to a peaceful death?I am surprised that 100 per cent. of respondents did not say yes to such a loaded question.
If we want to see where the euthanasia road, which the VES, the Law Commission and the BMA would have us follow, is taking us, I would simply point to the tragic situation that has arisen in the Netherlands. There, literally thousands of patients die every year through the deliberate act or omission of their doctors. It is now accepted that many of those patients have neither requested nor condoned the ending of their lives. That is a fact. That is why we must highlight the dangers of treading the path that leads to euthanasia.
To those who say that euthanasia is practised only at the request of patients in the most serious of cases, I would draw to their attention the revelation in a recent edition of the British Medical Journal that euthanasia has been sanctioned in the Netherlands for patients who simply have the misfortune to suffer from depression, and that doctors in the Netherlands are now admitting to euthanasia of new-born handicapped babies, who could not possibly have requested the ending of their own lives. That is the reality of going down the path to euthanasia.
To those who deny the validity of that comparison or who doubt that the authority of the House is being usurped by the campaigners for euthanasia, I repeat the words of John Oliver of the VES in the February edition of GQ magazine, commenting on his views on changes in the law in an article entitled, "Death on Demand":
I doubt that politicians will have the balls to change it themselves … Instead change will probably come in the form of judicial review, with the law being reshaped in the courts—exactly as it was in Holland in fact.Let me deal now with the issue of advanced directives, or "living wills" as they are sometimes called. It is, and always has been, good medical practice for doctors to 154 discuss with their patients the possible outcomes of their condition, the side effects of possible treatments of that condition, and the problems which might be encountered in the future. It is equally good medical practice for the views and opinions of the patient expressed in such discussions to be noted and taken into account by the doctor in the future management of a particular case. To suggest, however, that such opinions should be binding upon the doctor is as much an affront to the doctor's professionalism as it is a denial of proper care to the patient.
It is an approach fraught with desperate dangers. A patient having signed away access to treatments developed at a later date would deny himself or herself, probably unintentionally, the benefits of any progress in medical science. A patient in relatively good health looking forward to a future of uncertainty and eventual dependence on others might be prompted by vanity, pride or concern, among many other understandable emotions, to sign away his or her right to life, without any real knowledge of the emotions that might be felt or would be felt when that stage in the condition was reached.
A patient—this could happen so easily—surrounded by greedy or selfish relatives might feel pressured into signing, quite literally, his own death warrant. The cost pressures of the new nursing and residential care arrangements under the community care programme can only exacerbate those very real dangers which face people and their families today.
As Peter Millard, the Eleanor Peel professor of geriatric medicine at St. George's hospital medical school, in a letter to me welcoming this debate, said:The major flaw with advance directives is that the concept is based upon single diseases with known outcomes. Whereas medical practice in old age is based on a complex interweave of biological psychological and social factors complicated by multiple pathology. Mismanagement does not necessarily cause death, rather it leads to the bed-bound state. Old people do not want to be a burden and often when sick say they think they would be better off out of it. Advance directives based on oral and written evidence would lead to neglect.That is what a well-known doctor in geriatric care believes could happen if we trespass down the path to euthanasia and living wills. Is that the situation that the Law Commission and the British Medical Association wish to create?
There are always those, of course, who cite hard cases in support of their arguments. In this debate, the case of Tony Bland, the victim of the Hillsborough disaster, is one such example. It is also a case which many commentators misunderstood by thinking that it was simply a matter of switching off a life support machine. But that was not the case. Tony Bland was not on a life support machine. He was breathing unaided and was certainly not about to die. Furthermore, he never requested euthanasia. The question which the court was asked to decide was whether food and water could be withdrawn from a patient who was neither dying nor in the final stages of a terminal disease.
The Law Lords decided, in their wisdom—wrongly, I believe—that food and water could be so withdrawn without any recourse to Parliament for authority for that ruling. Therefore, Tony Bland was deliberately killed through lack of hydration and nutrition.
§ Mr. Julian Brazier (Canterbury)
Quite apart from the fact that bad law seems to have been made on a single 155 hard case, there is another angle to this which was not widely explored in the public domain. Tony Bland contracted septicemia earlier on. As the Guild of Catholic Doctors remarked, treatment for that septicemia could have been regarded as over-burdensome. Therefore, this case need never have come to the sort of invidious decisions that my hon. Friend mentioned.
§ Mr. Winterton
I am coming to that very point now. However, I am grateful to my hon. Friend for emphasising it, because it highlights the part of the case that I am seeking to present.
That case causes grave concern. Can we, as a civilised society, sanction the starving to death of a patient? I am not, equally, arguing that Tony Bland's doctors should have officiously striven to keep him alive. It might, in certain circumstances, have been ethical to withdraw treatment for infections which he contracted during the course of his condition, and he might have died as a result of that course of action. But that is not euthanasia: it is a judgment about the extent to which doctors should strive to keep alive, not about whether it could ever be ethical to withhold food and nutrition intentionally to kill the patient.
§ Mr. Frank Field (Birkenhead)
Does not the case of Tony Bland illustrate the two sides to the argument? The hon. Member has made a powerful case that we should be mindful of allowing society to slip into a frame of mind in which we dispose of people who are costly or inconvenient to us. But do not the horrors that Tony Bland's parents had to go through illustrate the other side of the argument? If medics treating someone are fearful that they will be reported for having allowed the patient to die, they take the Tony Bland line.
I very much agree with the view of the doctor on the "Today" programme, who was somehow billed as a pro-life doctor—as though all doctors were not pro-life—who said that twice Tony Bland had pneumonia, and twice he should not have been treated, allowing death to take place that way. I agree that we have the worst of all possible outcomes with the court judgment on the Tony Bland case, but surely it illustrates the other side of the picture: we do not want groups of people rushing around hospitals reporting other people because they may have caused someone's death. If that happens, we shall have the Bland episode all over again.
§ Mr. Winterton
I do not think that any Member of the House could disagree with what the hon. Gentleman has just said. I had the honour, pleasure and privilege to meet Tony Bland's parents and one of the doctors treating him after a Granada programme broadcast from Manchester. Following that meeting, I made representations to the Home Secretary about precisely what the law was.
It is not until one is faced with the sort of case to which the hon. Gentleman and I have referred that one understands the great problems. The hon. Gentleman is right to say that the Tony Bland case does, to an extent, expose both sides of the argument. But what my hon. Friend the Member for Canterbury (Mr. Brazier) said was right. Prior to any application being made to the High Court, Tony Bland suffered not only septicemia but a urinary fistula, and if an aggressive treatment had not been adopted to overcome those problems, he would have died naturally.
156 While I am putting the case against euthanasia, I must also say that I believe that that is what should have happened. There should not have been aggressive treatment to cure that septicemia because, like pneumonia, septicemia is an illness which strikes people in such a condition. It is wrong to use all the technology that medicine now has to keep someone alive in such circumstances.
§ Mrs. Winterton
I am pleased that my hon. Friend has given way to me and I shall be brief. Will my hon. Friend also confirm that the Tony Bland case shows that where lawyers are involved there are always great problems? The life of Tony Bland was lengthened because of legal interventions. He was not allowed to die naturally with dignity because of the case in which he had been involved, to which the Hillsborough disaster gave rise. Therefore, it was an extraordinary case in its own right and should not be taken literally. Many people got the wrong end of the stick about it.
§ Mr. Winterton
I can only say, not wishing to protract my speech much longer, that my hon. Friend has made a good point which should be noted by the House.
§ Mr. Clive Soley (Hammersmith)
How would the hon. Gentleman extend the argument? If a person who was fully conscious and facing death refused treatment, does the hon. Gentleman think that treatment should be administered without that person's consent?
§ Mr. Winterton
Personally, I do, because I believe that the decision about treatment should lie with those who are treating the individual. It is a doctor's duty to represent the best health interests of the individual and to ensure their well-being as far as possible.
The hon. Gentleman seeks to say that, in addition to the right to live, which is enshrined in the United Nations charter and in the constitutions of many countries, there is also the equivalent of a right to die. In fact, there is no such right to die. Prior to the Suicide Act 1961, it was illegal for people to commit suicide. Moreover, it is still illegal to assist people in committing suicide; it is criminal to do so, and that is right.
I conclude my introduction to today's debate by reminding the House that such was the strength of opposition to euthanasia that the hon. Member for Ealing, Southall (Mr. Khabra), whom I am glad to see in his place, withdrew his ten-minute Bill some time ago once he realised how resoundingly it would be defeated, and that instead the House gave leave, without Division, to my hon. Friend the Member for Keighley (Mr. Waller) to introduce a Bill which would reaffirm our opposition to euthanasia, commend the work of the hospice movement, make clear the circumstances in which food and water could and could not be withdrawn, and thus make it clear that the intentional killing of patients by action or omission is contrary to the will of the House.
Any change in the law must be considered and enacted by Parliament—by this House, and by the House of Lords—rather than being dictated by the courts, the lawyers or even the medical profession. Those who, like 157 me, care about the sanctity of human life and the dignity of patients stand at an important crossroads. They can accept euthanasia as inevitable—as the Voluntary Euthanasia Society, and its supporters in the Law Commission and the British Medical Association would have them do or they can join me in rising to the challenge, and drawing a line beyond which we will not allow society to go. Developments in the hospice movement, and in palliative and geriatric medicine, make euthanasia an out-dated and redundant concept that has no place in a civilised and caring society. Now is the time to call a halt to the slide.
§ Mr. Deputy Speaker (Mr. Michael Morris)
Order. It is clear that many hon. Members wish to speak. I make a plea for succinct speeches.
§ 12 noon
§ Mr. Frank Field (Birkenhead)
I am glad to have been called, and to follow the speech of my hon. Friend—as I shall call him this morning—the Member for Macclesfield (Mr. Winterton). I disagree with none of his substantive points, but I should like to garnish his speech, as it were, with a couple of nuances.
Euthanasia's recruiting sergeant is the simple and awful fact that relatives of many of us and our constituents have died in awful conditions, suffering dreadful pain over long periods. Because the methods of treatment applied in hospices are not universal—and not wanted by some patients—such people will continue to experience agonising deaths, and that will add force to the euthanasia debate. I do not think that we should dispose of that side of the argument.
§ Mrs. Ann Winterton
The hon. Gentleman is absolutely right. Has not the medical profession a huge part to play? Should not medical education and training, and the advice available to general practitioners, show the way forward and enable the right care to be provided?
§ Mr. Field
Indeed. I hope that the Government will accept the truth of that. Lord McColl, who works as a doctor in one of London's hospices, has advanced an effective argument that meets the hon. Lady's point. In the hospice where he works, patients come and go—as they now do in all hospices—and most control their own drug supplies: any patient who wished to commit suicide could easily do so simply by increasing the dosage. Throughout the time during which Lord McColl has worked in that hospice, however, not one has done so, because the hospice has been successful in controlling pain.
Let me sound two notes of caution in regard to the legalisation of euthanasia. First, there is the danger of creating a climate of opinion that will lead initially to the acceptability of euthanasia and a change in the law, and subsequently—a worse development—to a feeling on the part of old people in particular that they have a duty to volunteer. As the hon. Member for Macclesfield pointed out, according to evidence obtained some years ago more than 1,000 people in Holland have been killed without their permission.
In a briefing given to some of us, the Dutch ambassador disputed that evidence. It is possible that he does not understand what is going on in his country as well as 158 some of those involved in the debate—which underlines the importance of obtaining the most up-to-date and accurate information available.
Some 50 per cent. of the NHS budget is now spent on elderly people, and there will be increasing pressure for its control. It cannot be a fluke that the euthanasia debate has flared up again at a time when most European Governments face rising hospital bills for old people. The argument has an economic dimension. I fear that people may eventually volunteer to be killed because they feel that they are a burden.
Our parents considered it their duty to look after their own parents; now, it is increasingly felt that elderly parents should not live with their offspring. I wonder whether those elderly people are being entirely honest when they say that they prefer independence. Perhaps they feel that they would impose a burden on their families—and, if they already feel that when they are still able-bodied, although needing some care, what must the pressures be in the final years and months of their lives?
My second note of caution concerns "living wills". One of my best friends was known to the country as Barbara Wootton, and known in the other place as Lady Wootton. She was one of the most intelligent people of the century; for most of her life she was an atheist, but—being ultra-rational—as death approached she became agnostic.
When the debate about euthanasia and the role of Exit was last doing the rounds, I visited Barbara at her barn outside Dorking. She told me calmly that she had joined Exit. Shortly before that, a woman had allowed an Exit representative to look after her mother; hearing a loud noise, she had rushed into the room and found a man wearing a woolly hat and eating banana sandwiches while her mother was suffocating, with a plastic bag over her head. The daughter ripped the bag off.
I joked with Barbara, saying, "You cannot be put away by a man in a woolly hat who will eat banana sandwiches and put a bag over your head." Some time later, she said, "I have friends in the Lords who know about these things. They have given me the knock-out pills."
The next stage in this sad tale was when, during my regular Wednesday afternoon tea with Barbara, she said, "Do you know, Frank, last week I heard part of my brain collapse. It was like water moving down past my left ear." It was clear then that, although she was hyper-intelligent, decline had set in.
After one of the summer breaks, Barbara went into a geriatric hospital, where I visited her. For part of the time she was as bright as ever, but, notwithstanding all the care provided by the hospital, she told me, "I am keeping a list in my handbag of the differences between this place and prison, and so far it is not very long." I thought that she would ask me to go to her home and fetch the pills that were there to kill her.
The hon. Member for Macclesfield has described the consequences of such an action; although I disagree personally with suicide, and hope that I would hold to that view, I feel that others should be able to exercise the right. It was noticeable, however, that, however difficult things became for Barbara in those last months of her life, she fought to live with unbelievable determination. She did not ask for the drugs that would have killed her.
I do not suggest that everyone would find himself or herself in the same position, but I do issue a warning about "living wills". Had they been in vogue at that time, 159 Barbara would certainly have written one. However, when it came to the crunch, when she was not as in control as she had been previously, other forces took control of Barbara and she did not want the end of her life to be brought forward unnaturally. That is my second cautionary tale.
The last point that I wish to make in this important debate again underlines some of the themes adopted by the hon. Member for Macclesfield. One of the gains we want from the debate is not just the learning process but what we hope will be imparted to and induced into the medical profession. The Tony Bland example illustrates the different ways that the debate flows.
We know that euthanasia is practised in this country. Lord Dawson, who was King George V's doctor, said quite openly that he had killed the King. He did so because he was anxious that The Times should carry the story exclusively, rather than it being carried in other newspapers that he thought were a rather minor concern. He felt that something so important should be reported in what he thought to be the premier newspaper. If it is possible in this country for a doctor to do that and quite openly say that he has done that, for no prosecution to follow, and for that to happen in the 1930s, it underlines the important point that, quite clearly, some doctors are perhaps too happy about ending people's lives, whereas other doctors are fearful of doing so.
I hope that this debate does not imply that we are suggesting that people must be kept alive at all costs, whatever that does to them. However, there is a whole process relating to dying well in this country which, because of our hospice movement, sets us apart from most other countries in Europe and, perhaps, the world. We want to draw attention to that and we want to support the hospice movement. We only wish that the Government would be slightly more generous in their allocation of funds to that movement.
We must realise that, in all the key areas of our lives, although it is easy to stand up and say that there are black and white decisions to be made, most of us know that we are in a dreadful grey area.
§ Mrs. Marion Roe (Broxbourne)
I am very grateful to my hon. Friend the Member for Macclesfield (Mr. Winterton) for bringing this very important issue to the attention of the House today. As the Chairman of the Select Committee on Health and also of the all-party hospice group, I should like to say that this subject has occupied my mind for some time. It is apparent that, with the continued advance of medical science and the subsequent rise in life expectancy, there is a growing concern among many about the medical treatment and intervention that they would or would not like to receive if they were faced with a degenerative condition or a terminal illness.
That concern has naturally led to further discussion of the practice of euthanasia through the publication of articles and the showing or broadcasting of television and radio programmes. My attention, like that of many others, was drawn to the BBC2 screening of the Dutch television programme "Death on Request". I can tell those hon. Members who were unable to see the programme that the 160 film's theme was to trace the final months of a Dutch patient who was dying of motor neurone disease and was suffering terribly. His doctor said that there was nothing that he could do for him and that he was likely to suffocate to death. The final stages of the film showed the Dutch doctor administering a lethal injection to his patient.
The debate surrounding the programme was intense, with some describing it as a sensitively created programme, while the review by a senior geriatrician in the British Medical Journal described it as "propaganda". Watching the programme, I was concerned by some of the glaring inaccuracies of the film and even more so by the false impression that the feature created about the practice of euthanasia in the Netherlands.
First, the doctor stated clearly in the film that the patient would die of suffocation—a statement which caused considerable concern among motor neurone sufferers in this country. However, having discussed the matter personally with Dr. Nigel Sykes, one of the United Kingdom's leading experts in the care of those dying from motor neurone disease, I understand that, of the 300 motor neurone patients cared for at St. Christopher's hospice, none has died of suffocation.
Secondly, the doctor claimed during the film that where euthanasia was available, patients tended to live longer. However, no evidence was given to support that bold statement. Finally, the film failed to explain why no pain relief was given to the patient and why there were no home nurses or hospice support teams to help the wife.
Of more concern than the inaccuracies was the impression the film gave that the Dutch have effectively legalised euthanasia with no negative side effects, save the trauma of the doctor. Nothing could be further from the truth. As a result, I tabled early-day motion 740, which well over 100 hon. Members kindly supported. It criticised the BBC for failing to give a "complete and balanced" account of euthanasia in the Netherlands. My tabling of the motion caused a particularly strong reaction from the Dutch ambassador. However, the facts should give him some cause for alarm.
I was not the only one to notice the glaring shortcomings of the BBC in showing the programme without adequate prime time for comment and reaction. A letter to The Times the day after the programme was shown, signed by, among others, Dr. Twycross of Oxford university, the Archbishop of York and Lord Walton of Detchant, stated:having embraced the practice of euthanasia, the Dutch now find themselves on a slippery slope which not only involves euthanasia for those who are not dying but also euthanasia without request".That was hardly the impression that the programme gave.
The evidence behind such a bold statement in The Times is accurate and conclusive. The Dutch Attorney-General's Remelink report of 1991 stated that, in 1990, in addition to the 2,300 cases of voluntary euthanasia, there were 1,030 deaths from euthanasia without the patient's request.
If further evidence is needed of the slippery slope, it came last year in the Chabot case—in which the Dutch supreme court upheld a Dutch doctor's decision to administer a lethal injection to a woman who was suffering from depression as a result of family difficulties. Johan Legemaate, the legal adviser to the Royal Dutch Medical Association welcomed the "pragmatic decision", 161 confirming that mental suffering could be the basis for euthanasia. I am sure that many people in the UK, even in the medical profession, are unaware of that alarming development. I note that Dr. Chabot has now been reprimanded by a medical disciplinary board in Amsterdam.
There is further evidence to suggest that the legalisation of euthanasia by the Dutch authorities has had a negative impact on the quality of care available for those suffering from degenerative and terminal conditions. It is common sense to presume that where euthanasia is an option, the incentive to improve services for people who are terminally ill or for further research into pain relief will not be so strong and the resources not so forthcoming. In 1989, a study at the university of Amsterdam of 79 cancer patients showed that only 29 per cent. had been treated appropriately. More than half had been treated inappropriately or not received any treatment at all.
Furthermore, the hospice movement is virtually non-existent in the Netherlands. A recent parliamentary question revealed that it had only five hospices, compared with almost 200 in the United Kingdom. In response, the Dutch state has said that it has a well-developed system of nursing homes, which, indeed, it does. However, I am informed by leading palliative care specialists that they fail to provide palliative care as we know it in this country. The experience of one hospice doctor in the Netherlands recently reported in the Observer would support that.
Dr. Zylicz of the Rozendaal hospice near Arnhem states that he visits patients who want euthanasia because no one has told them how their pain and distress can be alleviated. This is not surprising, because palliative care has yet to be established as a medical discipline in the Netherlands and is not an integral part of medical training. There is much that can be learnt from current practice in the Netherlands. It is evident from the facts that, once euthanasia is legalised, non-voluntary euthanasia will follow and the vulnerable and weak members of society may feel pressurised. Dr. Zylicz claimed that one of his patients went to his hospice while her doctor was away, for the doctor had been putting pressure on her to request euthanasia.
A further point of concern is the manner in which euthanasia has been legalised. Technically it still remains a crime under the criminal code. However, in 1994 an official decree stated that doctors might avoid prosecution if life was actively terminated in a range of circumstances. The Dutch have arrived at the current position through judicial review via a number of difficult court cases. I fear deeply that the same could happen in this country unless Parliament is wise to it.
As my hon. Friend the Member for Macclesfield has already stated, the Voluntary Euthanasia Society has gone on record as stating that it expects change, not through Parliament but through judicial review. The decriminalising of intentional killing, regardless of the circumstances for which it was permitted, would be the dismantling of a fundamental principle on which our society and civilised behaviour are based. If such a significant change is to be discussed and considered, then Parliament, not the courts, is the proper arena.
I remain firmly opposed to euthanasia, which I understand to mean intentional killing either by act or omission as part of medical care. I do not believe that we 162 should keep people alive as long as possible. I feel strongly that there are times when it may be appropriate to withhold or withdraw medical treatment.
§ Mr. Andrew Rowe (Mid-Kent)
One of the pressures on the medical profession could derive from the Government's collection of statistics, league tables or whatever one likes to call them. There is a danger that there will grow up a premium in the number of deaths that a unit has managed to avoid. Quite a few young doctors in particular already show excessive enthusiasm for trying, for example, to revive patients who have died peacefully and bring them back, often damaged. My hon. Friend, particularly in her role as Chairman of the Select Committee, might like to think about that.
§ Mrs. Roe
I take the point that my hon. Friend makes. It is not on our list of subjects to be examined by the Select Committee at present, but it is surely clear that common sense must prevail. I assume that the medical profession must have a serious role in the matter and give direction from the top of that profession.
Furthermore, I endorse the right of a competent patient to refuse consent to any medical intervention, for whatever reason. In such circumstances, I understand that the doctor must be sure that the patient understands the likely consequences of any such refusal. However, no member of the health care team can overrule such a decision except in certain defined areas of mental illness. I support that. However, the right to refuse medical treatment is very different from the request for euthanasia.
As Lord Walton of Detchant, the Chairman of the Medical Ethics Select Committee in another place, stated in summing up the views of his Committee, there was not sufficient reason to weaken society's regard for intentional killing:Individual cases cannot reasonably establish the foundation of a policy which would have serious and widespread repercussions".— [Official Report, House of Lords; 9 May 1994, Vol. 554, c. 1346.]Lord Walton went on:our decision was significantly influenced by the outstanding achievement of the palliative care movement in the United Kingdom".—[Official Report, House of Lords; 9 May 1994, Vol. 554, 1346.]During the past few years, I have arranged for a number of Members of both Houses to visit hospices in the London area, and many have been surprised by the quality of the medical expertise and the nursing care.
Through research and development, the hospice movement can alleviate pain in 96 per cent. of patients treated and in the remaining 4 per cent. it can be reduced, although perhaps with some difficulty. Although much has been achieved which the Committee commended, there remains much to do, and I draw the Minister's attention to the development at Oxford currently under way the Oxford International Centre for Palliative Care, of which I am a patron. The centre, to be attached to the two universities, will seek to disseminate knowledge on hospice care in this country and abroad. Having secured planning permission and a lease, the centre is raising the necessary £5 million to begin development.
I hope that we as a nation can learn from the current practice of euthanasia in the Netherlands. In addition, I hope that every encouragement can be given to the hospice alternative, which has achieved so much since the founding of St. Christopher's in 1967 and which remains a beacon of hope to many.
§ Ms Liz Lynne (Rochdale)
I support the hon. Member for Macclesfield (Mr. Winterton) in this debate. We already have informed consent in Britain. A patient can refuse medical treatment, as has already been said. The doctor has to explain what will happen if that medical treatment is withdrawn. No medical person can overrule that decision. But euthanasia is totally different. It is assistance in dying. That is what I am against.
I can understand people's desire to end the life of a loved one who is suffering. We have probably all been through the dilemma of watching someone we love dying in a tremendous amount of pain. But now 96 per cent. of pain can be alleviated through palliative care. As the hon. Member for Broxbourne (Mrs. Roe) has just said, the hospice movement has been doing an absolutely wonderful job by the care and love that it gives to patients and to the relatives of patients in dealing with the problems of a loved one dying.
The hospice movement also provides a dignified death and a tremendous amount of joy. I find incredible in hospices the amount of joy in the nurses, the patients and the relatives. It comes from the acceptance of death. The staff help the relatives to accept it and they help the patient to accept it. Patients know that they will have a dignified and peaceful death. Pain relief is essential. As the hon. Member for Macclesfield said, if delivering that pain relief shortens life, so be it, as long as that is not the reason for doing so.
Palliative care need not be residential—the Macmillan nurses give very good palliative care—but the Government must provide more funding for the hospice movement generally; I ask the Minister to take that on board.
We have such a well-developed hospice movement here compared with other countries such as the Netherlands, where euthanasia is not supposed to be legal but is permitted in certain defined circumstances. Procedures there are supposed to be tightly controlled, but as the Remmelink report stated in 1990, which is some years ago, 1,030 patients who had not requested death had their lives terminated. That is the slippery slope.
The hon. Member for Broxbourne highlighted the case of the 50–year-old woman suffering from mental stress. There was nothing physically wrong with her, but the doctors and lawyers agreed that she could die. That is extremely worrying, especially for elderly, sick and disabled people who will feel that they are under pressure to end their lives.
Now that a person's house can be sold to pay for nursing home care, such people will feel that they are under even more pressure to sell their homes so that their children will inherit something. A minority of unscrupulous relatives will urge them to end their lives. Most relatives are not unscrupulous, but if such a measure passed into law a few would be. People do not like to hear that, but we have to face the facts. The only reason that the majority of people want to end a relative's life is to stop the suffering, but now that more pain relief is available that is not necessary. We must ensure that pain relief is given and that people can end their lives in dignity.
I urge hon. Members on both sides of the House to support the hon. Member for Macclesfield and to reject any move to legalise euthanasia. I have respect for life and believe that God, and not people, should take that life.
164 Whether or not people believe, we will be on the slippery slope. However well motivated the calls for voluntary euthanasia, I urge all hon. Members to reject them.
§ Mr. Piara S. Khabra (Ealing, Southall)
So far I have heard only one side of the debate. As the House will know, I introduced the Voluntary Euthanasia Bill about two years ago. I must inform the hon. Member for Macclesfield (Mr. Winterton) that I did not withdraw it—for certain reasons it was introduced from behind the Chair.
The hon. Member for Macclesfield has adopted a very aggressive style throughout this debate. His speech was mostly based on scaremongering and was an attempt to stifle the debate on this important issue. The House has the right to listen to the other point of view as well. I am fully aware that conservatism, with a small c, dominates this House but the hon. Member has tried to ridicule the Voluntary Euthanasia Society and the opinion polls that have clearly shown that opinion is shifting away from the old attitude that we should not discuss the right to chose to take one's own life when one is suffering from an incurable disease and in awful pain and does not wish to remain in this world.
I must make it clear that I shall be talking only about voluntary euthanasia, with the emphasis on the word "voluntary". It is important to make that distinction, otherwise the debate is confused. I shall emphasise the importance of voluntary euthanasia as the free and willing choice of a competent adult. Modern understanding of voluntary euthanasia is that it should happen when a patient requires medical help to die because he or she is incurably ill, or suffering unbearable distress from his or her condition.
The right to exercise that choice entirely sums up what the voluntary euthanasia movement is about, both in this country and throughout the world. We are not talking about non-voluntary, non-consensual killing of infants, the elderly, the sick or other vulnerable people. Voluntary euthanasia should be one of the choices that is available to people at the end of life.
§ Mr. Khabra
No, not yet
The freedom to choose is one of the fundamental values of a multi-party democracy and I hope that hon. Members on both sides of the House, who were elected through free and democratic choice, will welcome the extension of that choice.
The freedom to choose increases a person's expectation that he or she will have increased autonomy over all aspects of life. It is not flippant to say that, just as people can choose to adopt a life style and not be condemned for it or forced to adopt another style by society, at the end of life people should have the option to choose what is best for them. The increase in the expectation of personal autonomy is one reason why support for voluntary euthanasia has increased to its present level of about 80 per cent. among the general public. The hon. Member for Macclesfield ridiculed that out of all proportion.
165 The other key element in the increase in support for voluntary euthanasia is the desire to avoid unnecessary suffering. Even in our medically advanced society, it is a sad fact that many people suffer unbearably before death comes as the only release.
I have known two people who have suffered in such a way, and hon. Members should be aware that they suffered because their pain could not be cured. I know one person who died after being bedridden for three years. He suffered awful pain and could not move from his bed and, despite the most modern treatment, he finally could not survive. I used to visit him. He lived in a small town in Kent and had spent his whole life fighting against British imperialism. When he returned to India, he became a very important person and was elected as a member of a state legislature.
When he started to suffer from awful pain, he got the best treatment in India because of his contacts with the medical profession and his political friends. When he could get no relief from the pain, he decided to come to this country. He had the best possible treatment here but could not get rid of his pain. At the age of 92, he told me that he had no wish to live in this world. He said that he had seen the whole world and asked why he could not take his life as he did not want to live. He said that he was not living but was just a cabbage. He could neither move nor talk properly but was mentally alert. He wanted to take his life but was not allowed to take that decision.
Another constituent who has spent nearly 35 years in this country has been in bed for nine years. He cannot sit without assistance, he cannot eat properly or go to the toilet. Despite the fact that he is a religious man and believes in God, he thinks that it is not worth living and wishes to die, but he cannot.
May I make it clear that I do not ignore or seek to downgrade the wonderful work of the hospice movement? Hospices are truly wonderful places that provide invaluable care for many people, allowing them to die with dignity and the minimum of suffering. I very much admire their work, but even the best-managed hospice cannot keep everyone free from pain. Palliative care experts, often hospice doctors, accept that not all terminal pain can be controlled.
I have heard the slippery slope argument, which is another scare story that is being spread around the world and this country. Opponents of voluntary euthanasia argue that voluntary euthanasia will soon lead to involuntary euthanasia—the so-called "slippery slope". The slippery slope argument has been used against every social reform in the history of this country, but there is no evidence for it. Voluntary euthanasia is entirely about personal choice and is distinct from murdering people whom others judge to be of less worth. I would not support legislation for involuntary euthanasia.
Some people are afraid that, if euthanasia becomes legal, it will be abused. I recognise and fully understand that fear, but nobody knows how much abuse takes place at present. Active euthanasia is practised outside the law. If it were brought out into the open and strictly controlled, as it is in the Netherlands, abuse would be less likely. For instance, at present, doctors allow patients to die by withholding treatment or not resuscitating after a heart attack. No one suggests that they do so because they want to free beds or are conspiring with greedy relatives. Safeguards against such abuse can be incorporated in future legislation.
166 It is time that the House reflected public opinion and brought the issue of decision making at the end of life out into the open. The decision to end life should be in the hands of those most involved—the patients. In the absence of a law permitting medical help to die, the power to control one's own destiny can be exercised by completing an advance directive or "living will", as they are often called. Drawing up an advance directive while a patient is of sound mind and body allows the patient to state clearly that, with a given prognosis, he or she does not want life-prolonging treatment.
Many thousands of people have already signed advance directives because they live in fear of having a tortured experience prolonged by medical technology and want to express their wishes in advance. Personally, I believe that prolonging life through artificial, modern technological means was also against the wish of God.
I welcome the great advance in patients' rights with the recent report by the Law Commission and the new code of practice recently issued by the British Medical Association. Between them, they have established that advance directives have legal force, which must be respected by an attending doctor. They also acknowledge that patients have autonomy over their decision, which doctors must respect. If unwanted life-prolonging treatment is given, the doctor is liable to be charged with assault. Those of us who do not want our lives prolonged unnecessarily are grateful for the acceptance of our right to refuse unwanted medical treatment.
Allowing patients to die by withholding medical treatment is not enough. Those of us who want medical help to die should have our pleas for help answered, as that can be the only humane and compassionate response to people's need.
The House should consider the fact that the country wants some sort of legislation so that those who suffer from incurable disease and want to take their own life should be allowed to do so. Obviously, there should be guarantees against abuse. If a law is passed by the House, it must incorporate guarantees and safeguards to prevent people from using unauthorised means or exploiting the situation, and make them responsible under the law if that happens. I hope that the House will consider the fact that there is another viewpoint, although the majority of hon. Members are not yet prepared to support such legislation.
I admire and praise the Voluntary Euthanasia Society's efforts to start this democratic debate, which people have a right to discuss. People should not be muzzled. A Bill should be introduced so that we can take further steps to discuss this important issue.
§ Rev. Martin Smyth (Belfast, South)
I welcome the opportunity to make just a short contribution and to share my thoughts with my hon. Friends and those under whose chairmanship I have sat on the Select Committee over the years. The fact that we are debating this subject today shows that there is no stricture on open debate, and I am amazed at the closing comment by the hon. Member for Ealing, South (Mr. Khabra). It was obvious that he had not even listened to the presentation of the Select Committee Chairman, who underlined the fact that euthanasia was not properly controlled in Holland and said that even the Netherlands ambassador to this country was not aware of what was going on.
167 When one denies the concept of a slippery slope, one must face the fact that doctors, nurses, lawyers and parliamentarians are all human. In every walk of life, people try to broaden the law to suit themselves. To suggest that it is not necessary to have restrictions stands against the revelations that have been made, even in the House today. An outstanding physician decided to terminate a monarch's life to hit a Times headline. The reality is that the law has been just ignored. Now we find that there are moves to broaden that law, which will be further ignored.
Depression hits most of us to some degree or other. The Old Testament contains a lovely illustration of a prophet who was in absolute depression and who wished that he might die. There was no Voluntary Euthanasia Society to help him then and the Almighty did not answer that prayer because He had something better for him. One may deny the authenticity of the scripture, but it tells us that he was taken to heaven later in a fiery chariot.
The apostle Paul, who suffered as much as any person, physically, mentally and morally, in prison and out of prison, had that most human of all wishes, that he might die, to be absent from the body and to be present with Christ, which would have been better by far. He realised, however, that there was a task to be done, and he continued to do that task.
Today, I not only support the speech by the hon. Member for Macclesfield (Mr. Winterton), but ask that we examine a little further the people who propose these movements. I know that in the House from time to time—I speak as a non-member of the masonic order—some people constantly see the masons behind everything. In the move to change society's thinking, could we ask the Eugenic Society to publish a list of its members so that we might know who is to the fore in so many spheres of life and changing society?
It is fascinating to see how people come along. The commission recommending changes in euthanasia includes a person who spent some time in Northern Ireland—Professor Simon Lee. He used the same philosophy to try to introduce into Northern Ireland the concepts of the Abortion Act 1967. He is seeking to broaden what is called voluntary euthanasia in the commission.
On living wills, I would have thought that lawyers would recognise that even people of sound mind regularly change their minds through life, and change their wills. I would have thought that, even on their death beds, some of those folk make valid changes to their wills. I do not believe in the concept of living wills because people change their minds.
I ask you, Mr. Deputy Speaker, and right hon. and hon. Members to bear in mind the let-out that one doctor suggested—that a voluntary living will may just say, "I wish to die at home". This might sound like music to the Treasury, because it would obviate any extra hospital expenses, but it could open the door for doctors, of whom some have taken the decision into their own hands, to administer the fatal dose that would terminate a person's life. We should not go further down that road—ostensibly in the name of freedom of choice—because we would create a position whereby people who need care and treatment will not be given a choice..
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I am sorry that, because of the large interest in the debate, at least one hon. Member who wished to speak has been unable to do so, but I feel obliged briefly to give the Government's view, as my hon. Friend the Member for Macclesfield (Mr. Winterton), who secured the debate, asked me to do.
Euthanasia, as literally defined, means "an easy death" but the term is commonly used and is understood to mean mercy killing—the deliberate killing of someone, at his or her request, in a terminal condition and usually in severe pain or distress.
That topic provides scope for enormous argument, as has been shown today. It is not surprising that the House of Lords was inspired to set up the Select Committee on Medical Ethics, which considered that topic and the issues surrounding it. That Committee did an excellent job in sifting and analysing the mass of evidence that was put to it, and it reached some conclusions on what is a sensitive issue. That could not have been easy, given the opposing views held by many of the people who gave evidence.
Some of the key issues were debated in another place on 9 May last year. I am pleased that the House has had an opportunity to do likewise and to pay tribute to my hon. Friend the Member for Macclesfield for raising the matter. The Government's overriding concern in the issue is to protect patients' interests, to safeguard the patient's right to consent to or refuse treatment, to ensure that adequate protection is given to people who are in no position to speak for themselves, and, most important, to ensure that actions that have as their intention another person's death continue to be unlawful.
As the Government's published response has made clear, we welcome the Select Committee's report, and we agree with the majority of its findings. The report's key element was the clear rejection of the case for the legalisation of euthanasia. The Committee did not accept that the arguments in favour were sufficient reasons to weaken society's prohibition of intentional killing. It said:prohibition is the cornerstone of law and of social relationships.It also said:The message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death, but should assure them of our care and support in life.We entirely agree.
It is essential to draw a clear distinction between euthanasia, which is a positive intervention to end life, and the withholding or withdrawal of treatment that has no curative or beneficial effect. The question of whether to withhold treatment from someone who is not benefiting from it is different from euthanasia, although it raises similar moral and ethical questions. It is a doctor's duty to advise and provide for his patient such treatment as is, in his professional judgment, in the best interests of that patient and consistent with a responsible body of medical opinion.
A person's right to refuse treatment is an important one. A patient has a right to say no to his doctors. That applies whether a patient's reasons are, and I quote a legal judgment:rational, irrational, unknown or even non-existent.169 Doctors have both an ethical and legal duty to abide by their patients' wishes. A clinician must of course be satisfied that a patient's decision to refuse treatment is genuine, made in a full understanding of the consequences, and not influenced by others. Someone who has a learning disability, who is mentally ill, confused as a result of drugs, or a child may not be capable of making a proper decision.
As the House has already noted, some people draw up advance directives or "living wills". They have been referred to in literature recently as advance statements, which are drawn up so that people's wishes may be taken into account in the future if, at that time, they are unable to express their views. Such statements are an extension of the patient's right to say no to treatment, and are supported by the House of Lords Select Committee on Medical Ethics and the Law Commission.
The commission makes recommendations, however, that advance statements be defined in legislation and their status clarified in law. We shall consider that proposal. Advance statements are of course nothing to do with euthanasia. They cannot require doctors to perform an illegal act such as deliberate killing.
I regard palliative care as one of the great advances in our society in recent years, as has been mentioned eloquently by hon. Members on both sides of the House. In recent years, we have continued to support, with a sixfold rise in central funding, hospices and palliative care services. We shall continue to do so. We recognise their enormous contribution. To echo what my hon. Friend the Member for Broxbourne (Mrs. Rowe) said, in Holland there is little palliative care.
In conclusion, I shall re-state the Government's opinion. We are not engaged in any action that we believe would take us down a slippery slope. We envisage no change to the law or practice at present. I emphasise that the Government remain firmly opposed to euthanasia.