HC Deb 10 December 1997 vol 302 cc1011-24 3.31 pm
The Parliamentary Secretary, Lord Chancellor's Department (Mr. Geoffrey Hoon)

With permission, Madam Speaker, I should like to repeat a statement on mental incapacity, which has been made in another place—[Interruption.]

Madam Speaker

Order. Let me get people out of the Chamber—it is very noisy. I am sure that hon. Members will move quickly and quietly so that we can hear the statement.

Mr. Hoon

Thank you, Madam Speaker.

In my answer to hon. Friend the Member for Corby (Mr. Hope) on 28 October 1997, Official Report, column 787, I said that it was the Government's intention to issue a consultation paper on the subject of mental incapacity. I am pleased to announce the publication of a Green Paper on that subject today. It concerns the law in England and Wales, and examines a wide range of issues concerning the legal rights of people who are unable to make decisions for themselves, or who cannot communicate their decisions, as the result of disease, disability, or injury.

As it currently stands, the law affords little protection either to mentally incapacitated adults or to those who care for them. The law is confusing and fragmented: many carers in particular are expected to make decisions on behalf of incapacitated adults without a clear idea of what legal authority there is for those decisions. Everyone will know of a friend or relative whose life is affected by the unsatisfactory state of the current law.

Let me provide just three examples: the first is a young man with a learning disability who has reached the age of 18 and wants to be able to make some decisions for himself, such as what clothes to wear, or where to live. A second example might be a young woman, formerly a high-flying executive until a severe car crash caused brain damage, making her incapable of taking all but the simplest decisions about her life, health or welfare. A third example would be an elderly woman who is suffering from dementia. She is in a home and currently there are concerns about how her finances are protected. The present law does not provide sufficient guidance or safeguards for each of the people I have mentioned, or for those who care for them. The Green Paper therefore invites views on the need to create a legal framework for decision making on behalf of people who lack mental capacity. The Government are determined that the law should be developed and modernised.

I must make it clear at the outset that the Green Paper does not seek views on euthanasia. Euthanasia is a deliberate intervention undertaken with the express intention of ending a life, at an individual's own request or for a merciful motive. That is not acceptable to the Government. We fully support the view of the House of Lords Select Committee on Medical Ethics in its report of February 1994 that euthanasia is unacceptable and cannot be sanctioned in any circumstances. Euthanasia is illegal now and will remain illegal, so let us not be side-tracked by that issue.

The current law lacks coherence because it has developed piecemeal. It is unsystematic and full of glaring gaps. It has many areas of uncertainty, and fails to offer adequate protection either for mentally incapacitated adults or for the people who look after them. The scale of the problem must not be underestimated. The range of people who are let down by the current law is extensive. They include adults with profound learning disabilities; victims of accidents, such as road traffic accident victims who suffer brain damage; those who lose mental capacity as a result of a stroke; and those who lose mental capacity later in life—for example, those who suffer from dementia.

In preparing the Green Paper, the Government acknowledge two debts. The first is to the Law Commission, whose work in this area culminated in 1995 in the publication of its report entitled, "Mental Incapacity". The Green Paper published today is based closely on the wide-ranging and coherent set of recommendations contained in the Law Commission's final report. The Government's second debt is to the House of Lords Select Committee on Medical Ethics, chaired by Lord Walton, whose report was published in 1994.

I recognise that many of the issues raised in the Green Paper are sensitive and attract strong views. The Green Paper seeks the broadest range of responses before policy can be settled. With the exception of our absolute opposition to euthanasia, the Government have no fixed or final views on any of the questions. We will develop policy only when the consultation process is complete.

The areas covered by the Green Paper include definitions of incapacity and what is meant by the best interests of an incapacitated person. It also considers the need for a more informal framework for those making day-to-day decisions on behalf of an incapacitated person. It looks at the possibilities open to someone who is able to make arrangements for a time when mental capacity may be lost. It examines the law relating to the making of advance statements and proposals for a new form of power of attorney that would cover health care and personal welfare issues, as well as financial issues.

The independent supervision of medical and research procedures is also considered, as is the possibility of increased protection under public law for people with a mental incapacity and any others at risk. Finally, the Green Paper looks at a possible judicial and administrative framework to supervise and regulate all those arrangements.

The first set of issues examined in the Green Paper are the key principles that underpin the Law Commission's recommendations. The first of those is the need to replace the variety of different tests of mental capacity with a single, straightforward statutory definition. The proposed test of capacity would focus in each particular case on the decision that has to be taken and on the ability of the person concerned to understand the nature of the decision required, as well as its implications. That would avoid unnecessary intrusion into an individual's personal affairs, and would allow for as much involvement as possible by him in the decision-making process. It would allow a person to continue to make everyday decisions about, for example, how his finances should be organised or what presents to buy for Christmas, even if that person was deemed incapable of making a decision about whether a particular form of medical treatment was or was not appropriate.

The second principle is that decisions on behalf of people under an incapacity should be made in their best interests. The decision maker should take account of a number of factors, including the ascertainable past and present wishes of the individual concerned; the views of others whom it is appropriate and practical to consult; and whether the purpose for which the decision is required can be achieved as effectively in a way that is less restrictive of the individual's freedom of action. Decisions taken on behalf of a person lacking capacity would therefore require a consideration of that person as an individual.

The Green Paper seeks views on the practical application of those criteria. For example, there may be differences of opinion between those who are to be consulted and conflicts of interest may arise. For example, two close relatives may differ about where a person should be looked after—a spouse might wish to continue to care for the patient at home, while a son or daughter might favour nursing home care.

The Law Commission also proposed that a legal framework be established to govern the many informal day-to-day decisions that are made by carers, family members or treatment providers on behalf of those under a mental incapacity. That legal framework would include a general authority for decisions to be taken on behalf of an incapacitated adult, provided those decisions are reasonable and in the person's best interests. The Government accept those proposals in principle, but remain concerned that any such system should have adequate safeguards built in to ensure that incapacitated people and their assets are protected against abuse. The Green Paper therefore seeks views on the additional safeguards that might be needed.

One area of the Law Commission report that has raised particular concern in some quarters is that involving health care decisions intended to have effect when a person loses mental capacity. Those decisions are commonly known as living wills, but a more accurate term—advance statement—is used by the Law Commission and in the Green Paper.

There is a misconception that the Law Commission's proposals would make legal provision for advance statements for the first time. That is not the case. Valid advance refusals already have full effect at common law. This means that a person who is worried about the possibility of a particular form of medical treatment already has the right to refuse that treatment by way of an advance refusal. A Jehovah's Witness, for example, can already refuse to receive a blood transfusion. That refusal is binding on the doctor and cannot be overruled.

An advance statement enables people to leave instructions about their potential medical treatment, in anticipation of a time when they are no longer capable of making decisions or of communicating them. The sorts of decisions that can be made are only those that a fully competent adult is allowed to make.

When mentally competent, each of us has the right to consent to or refuse any form of medical treatment. The instructions included in an advance statement would enable exactly the same decisions to be made, and can therefore include both consenting to treatment and refusing it. As is the position for competent adults, however, advance statements cannot force a doctor to give a particular type of treatment, or ask a doctor to do anything that is illegal. An advance statement could not, for example, ask a doctor deliberately to end life. The blunt truth is that if a doctor took such action, he or she would be exposed to a charge of murder.

An advance statement would, however, allow patients with cancer, who know that they may at some future time lose capacity to consent to treatment, or capacity to communicate that consent, to provide that consent in advance. An advance statement could even allow the patient to consent to the use of new drugs on a trial basis, if that is what the patient wanted. Equally, a terminally ill patient could request that treatment is provided to sustain life for the longest possible time, even if the resultant treatment might be thought by others to be unnecessarily burdensome.

The Government recognise that the Law Commission's proposals on advance statements raise complex issues on which many people hold strong personal, religious or ethical opinions. For that reason, the Green Paper specifically seeks views on whether legislation in this area is appropriate, and, if so, what its objectives should be.

The Law Commission was of the opinion that certain types of serious medical procedures, including sterilisation and donation of tissue or bone marrow, should receive additional independent supervision to ensure that the best interests of the incapacitated individual are properly protected. That supervision could take the form of consideration by the courts, an independent second medical opinion, or certain other types of supervisory mechanism.

The Law Commission suggested that, in certain limited circumstances, a departure from the best interests criteria, which I mentioned earlier, might be justified. One of those relates to the withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state. In view of the different opinions that exist about whether such patients can, in fact, be said to have best interests, the Government believe that it is important that the criteria are considered very carefully in each and every case that arises. The Green Paper seeks views on the vital ethical considerations that must be addressed in reaching decisions on the discontinuation of artificial nutrition and hydration in those cases.

The Law Commission also considered that there might be a case for departing from the best interests criteria in the area of medical procedures and research for the benefit of others. The commission recommended that it should be possible for those procedures to be authorised, in relation to a person without the capacity to consent to them, if the procedure would not cause the person significant harm and would be of significant benefit to others.

An example of that type of procedure is the removal of samples of blood or taking a mouth swab from the patient to investigate his or her genetic make-up. That could be of significant benefit to other members of the patient's family in identifying and treating inherited conditions. Procedures of this nature could also extend to non-therapeutic research into conditions from which the patient is suffering, for the benefit of others suffering from that condition. The Law Commission suggested that such research should be justifiable only where the procedures involved minimal risk for the patient.

The Green Paper seeks views on whether such research is ethical and reasonable, and on whether the conditions for research proposed in the Council of Europe convention on human rights and biomedicine provide adequate safeguards for patients unable to give consent.

The Law Commission also proposed an extension of the existing legal framework for enduring powers of attorney to include the concept of a "continuing power of attorney". At present, it is possible for people to make enduring powers of attorney to enable their property and financial affairs to be looked after if they become mentally incapable. The Law Commission's proposals would enable a person with capacity to appoint somebody to make decisions on his or her behalf if that capacity was ever lost. Under those provisions, the decisions that could be taken would cover health care and personal welfare matters in addition to financial matters.

The House of Lords Select Committee on Medical Ethics expressed concern that the decisions of attorneys are unlikely to be completely objective—for example, an attorney might find it difficult to decide whether to approve costly medical treatment or nursing care if he or she is either paying the bills or entitled to benefit from the patient's estate. Equally, given the changing nature of relationships, the choice of attorney might quickly become out of date and, by the time an attorney is asked to act, he or she might have lost the close rapport that once existed with the patient.

The Law Commission has attempted to take account of those concerns by proposing safeguards and by listing a number of areas where an attorney should not be able to act on behalf of a person without capacity. However, here, too, there are different views. The Green Paper therefore seeks responses on whether legislation in that area would be appropriate, as well as seeking comments on the Law Commission's detailed proposals.

The Law Commission also considered the need for new laws to ensure that a broader group of people are protected from abuse and neglect. That group would include people who may not be able to protect themselves, such as the elderly or those with serious physical illnesses, as well as those suffering from mental incapacity. In particular, it recommended that social services authorities should have a new duty to investigate cases of possible neglect or abuse, and should have short-term powers to protect people in those cases.

The Government believe that, although there may be merit in some of the Law Commission's recommendations concerning the new provisions, there may not be a pressing need for reform in the light of powers that already exist in this area. The consultation paper therefore seeks views on the need for legislation and on the practicalities of the proposals.

The Law Commission's proposals in each of these areas clearly have substantial implications for the legal and administrative systems that would be needed to manage and supervise their operation. The commission therefore recommended a new court jurisdiction that could deal with personal welfare and health care issues, as well as property and financial matters. The latter are currently dealt with by the Court of Protection and the Public Trust Office. The Law Commission's proposals would require a substantial extension of their jurisdiction, as well as offering an increased role for the civil courts.

The Government can see the advantage in having a unified jurisdiction in that area, but there would clearly be considerable implications for the court system, in terms of both resources and practicality. The consultation paper invites views on the structure proposed by the Law Commission and on the form and extent of court jurisdiction that would be appropriate in particular areas.

The Green Paper raises many issues of great sensitivity, complexity and importance. They must be addressed to ensure not only that the interests of incapacitated persons are adequately protected, but that those who must make decisions on their behalf have a clear legal framework within which to do so. The Government are determined to make progress in an area in which those who lack mental capacity, and those who care for them, are not adequately protected under the law today. The Government are equally determined that any reform should command the widest possible public support.

The Government have not yet made any decisions to legislate. Any legislation would be of wide-ranging social significance and of comparable scope and sensitivity to the Children Act 1989. I therefore hope that the Green Paper will generate a wide range of responses from all those with an interest in this area, whether professional or personal, in order to assist the Government in determining the best way forward.

Mr. Edward Garnier (Harborough)

I thank the Minister for his statement on what is, on any view, a very difficult subject. I shall not take too long in responding to the Minister's statement as I know that a great many of his hon. Friends want to spend much of today discussing the Government's conduct in relation to social security.

I am grateful to the Minister for making a statement in the House about a matter that is currently in the public eye, not least because of the Doctor Assisted Dying Bill, which the hon. Member for Bassetlaw (Mr. Ashton) will shortly seek leave to introduce. I must inform the hon. Member that I shall vote against his motion.

I take this opportunity to thank the House of Lords Select Committee on Medical Ethics and the Law Commission for their invaluable work. We may not always agree with their suggestions and proposals, but they are always considered and cogent, and they deserve more parliamentary time. Indeed, the Law Commission's work receives precious little acknowledgment in the House. I trust that, to some extent, the Minister and I have redressed that.

I welcome the Government's announcement of a Green Paper on the Law Commission's draft Bill on mental incapacity. I hope that the consultation will be wide ranging and thorough, as there is a need for clarity and certainty in this aspect of the law, where little exists.

Is the Minister aware that English law appears to possess no procedures whereby a third party or a court can take a medical decision on behalf of an adult patient without capacity to take that decision? Is he also aware of the concern that public law provides no acceptable power to protect incapacitated or vulnerable people from abuse and neglect? Does he share my concern about clause 11 of the draft Bill, which would, if enacted, give scope to permit medical experiments on incapacitated patients without consent? I heard what he said about the limited nature of the proposal, but will he take on board the concerns that I and many other members of the public have about it?

I welcome the Government's firm stance against euthanasia. Will the Minister examine with the greatest possible care any proposals, from wherever they come, to legalise euthanasia, however clinically described, and to introduce so-called living wills? Disposing of the inconvenient, either by commission or omission, may be the next step.

The Minister spoke of the need for a more informal framework for making day-to-day decisions on behalf of an incapacitated person. Although I understand what he means, we should not lightly ignore the need for formality when the care of the vulnerable is in issue. I accept the Minister's analysis of the current law on incapacity, but he should tread very carefully down the path of rewriting the law without the fullest possible consideration of the legal, moral and ethical issues that are revealed by the Green Paper and the Law Commission report on mental incapacity.

Mr. Hoon

I am grateful for the hon. and learned Member's support. I agree that, after the Law Commission published its report in 1995, having considered the matter carefully over a long period, it was right that the Government should take the matter forward as urgently as possible. I agree that it is crucial to have wide-ranging consultation. When he examines the Green Paper closely, he will discover that we are consulting on about 107 separate questions. This is a Green Paper of the deepest green, and we are determined to secure widespread support for the proposals.

If I understood the hon. and learned Member correctly, he agrees with me in relation to the present inadequacy of existing law, but I was slightly confused by his comments that appeared to link euthanasia and what I prefer to call advance statements. I carefully distinguished between the two. The Government have no time for euthanasia. As I have said, they remain firmly opposed to any idea that euthanasia might be legalised. However, that is not to say that there may not be a role for advance statements that indicate the approach that people who are at present mentally competent may wish to take if they lose mental capacity. To some extent, such advance statements are already recognised in our law. It is important that we have a comprehensive approach to the matter and that we develop a framework in which these decisions can be taken properly.

Ms Gisela Stuart (Birmingham, Edgbaston)

May I congratulate the Minister on his statement, which is welcome? I congratulate the Government on taking the Law Commission's work forward, but, to prevent any confusion outside the House, will he make it absolutely clear that the proposals have no connection with either euthanasia or so-called doctor-assisted suicide?

Mr. Hoon

I am grateful to my hon. Friend for her comments. I repeat that the Government are firmly opposed to euthanasia, which is a deliberate action to end life. Anyone with the ability to make a decision is legally entitled to consent to or to refuse medical treatment. An advance statement is a way for a person simply to plan ahead for a time when he may no longer be able to make or to convey his decision. That distinction lies at the heart of my statement and of the Green Paper, and I am grateful to my hon. Friend for making that point again.

Mr. John Burnett (Torridge and West Devon)

We welcome the Government's open-minded approach to a difficult question. We realise that this part of the law is fraught with conflicts of interest. What is essential is independent advice for donors of extended powers of attorney, and for anyone considering making a so-called living will. Moreover, any witnesses to such documents must have proper independent medical qualifications. I hope that the Government will bear in mind the essential nature of those points before the matter proceeds further.

Mr. Hoon

I am grateful for the hon. Gentleman's support. I mentioned the importance of seeking to resolve potential conflicts of interest, and the need for greater safeguards, particularly in regard to the securing of independent advice and support for carers who must sometimes make very difficult decisions.

Mr. Tam Dalyell (Linlithgow)

As my hon. Friend is flanked by both Scottish and English Health Ministers, may I ask whether the Government will revisit the possibility of tabling amendments to the Human Tissue Act 1961 to allow a hospital to take the organs of those in whom clinical death has been established by at least two surgeons—neither of whom will be the beneficiary as a renal transplant surgeon—to increase the number of available tissues? That was discussed in detail in a debate that I initiated on Friday 3 March 1979, and has also been discussed in ten-minute Bills. I think that the proposal is well known to Health Ministers, and it would seem to provide an opportunity for legislation.

Mr. Hoon

As ever, I am grateful to my hon. Friend for his thoughtful contribution. I must tell him, however, that his proposal is well beyond the scope of the Green Paper, and is not the responsibility of my Department.

Mrs. Ann Winterton (Congleton)

The Minister has maintained that the Government are opposed to euthanasia, yet they have not abandoned those sections of the Law Commission's draft Bill that would enshrine deliberate killing by omission. I refer to the withholding of hydration and nutrition. Is not that euthanasia by the back door?

Mr. Hoon

No. It has nothing to do with euthanasia. Under the present law, medical treatment may be withdrawn if it is judged to be in the patient's best interest not to continue it.

Mrs. Winterton

What constitutes medical treatment?

Mr. Hoon

If the hon. Lady will allow me to explain, I will draw an important distinction.

Decisions concerning the withdrawal of artificial feeding from people in a permanent vegetative state must be referred to a court. The Green Paper seeks views on whether decisions on the withdrawal of artificial feeding of patients should always be made by the courts, whether a person with the new power of attorney to make treatment decisions can decide or whether there should be a "second opinion" procedure.

It is important to recognise that euthanasia is a deliberate act to end life. The intentional termination of life should not be confused with the withdrawal of treatment when it no longer has any beneficial effect, even though that may mean that patients die of their illnesses. Care to keep a patient comfortable should, of course, always be given.

The courts have held that when nutrition and hydration are provided artificially, they are being used to overcome a failure of bodily functions such as the ability to swallow. Just as dialysis to overcome kidney failure is medical treatment, so are artificial nutrition and hydration, which are used to overcome failure of some part of the digestive system.

Mr. Joe Ashton (Bassetlaw)

Is it not an amazing, breathtaking coincidence that the Government have managed to make a 20-minute statement just before my ten-minute Bill? May I reassure my hon. Friend that my Bill is not about euthanasia, and does not advocate euthanasia? I do not think that there was any need to make the statement today.

When does my hon. Friend intend these proposals to become legislation? Who will speak on behalf of terminally ill patients, and will there be any legislation to give those patients a choice?

Mr. Hoon

My hon. Friend is a distinguished former Whip, and has written about these matters. He understands how they work rather better than I do. I cannot give him any idea of a likely date for legislation, not least because we have embarked on an extensive programme of consultation, and we need to see the results before we can decide whether legislation is necessary.

Mr. John Greenway (Ryedale)

A few years ago in the House, I successfully sponsored a change in the criminal procedure affecting those who are mentally disordered and who come before the courts. I welcome the Minister's statement about the need to extend that arrangement to deal with people with mental incapacity. Does he agree that it would be a tragedy if the reporting of his statement led to its being seen purely in terms of a statement about euthanasia?

Day after day, tens of thousands of people in this country—some voluntarily and some professionally—care for those with mental incapacity. The Minister is ensuring a proper code of practice, proper guidelines and a proper framework within which decisions about those people can be properly taken. Can he assure the House that if, as a result of his consultation, a change in the law is seen to be necessary, he will speedily introduce the necessary legislation?

Mr. Hoon

I am extremely grateful to the hon. Gentleman for his support and I pay tribute to his work in this area. I have taken great pains to distinguish the problems of mental incapacity from the issue of euthanasia and I am grateful to the hon. Gentleman for his forceful observation. I hope that the result of the consultation will allow us to clarify the law in this area. Clearly, we must await responses to the wide variety of questions in the Green Paper.

Mr. Gerald Bermingham (St. Helens, South)

The Minister's statement is welcome and covers a considerable number of fields. I suspect that Law Commission reports and other evidence that will result from the consultation will spawn not one Bill but a number of them to deal with separate areas. If that occurs and such legislation is needed, for example, for the protection of carers and people with mental incapacity problems, if I may put it that way, does he agree that such Bills ought to be dealt with by way of a Special Standing Committee whose examination would precede debate in the House?

Mr. Hoon

I am grateful to my hon. Friend for his suggestions, but, having said it is important to await the results of the consultation before deciding whether a single Bill is necessary, I am in no better position to suggest that a number of Bills might be necessary. My hon. Friend's final observation shows the importance of ensuring that whatever the Government's proposals, they have the widespread support of the House and the wider population. This is a hugely delicate and sensitive area and we shall move forward only when we feel that there is widespread confidence in our decisions.

Mr. Nicholas Winterton (Macclesfield)

As a Member who is totally opposed to euthanasia in any situation, I am grateful to the Minister for his considered and detailed statement and for saying that the Government are totally opposed to euthanasia in any situation. However, he was less than frank about living wills or advance statements. Does he not accept that there are problems in this area, particularly when life-saving treatments may be developed after a person has made such an advance statement? He needs to look at that area with particular care, and so does the House.

Mr. Hoon

There is no need to repeat my and the Government's opposition to euthanasia. I share the hon. Gentleman's views. I recognise, and said as much in the statement, that there are difficulties about advance statements. That is why there is to be such extensive consultation. I specifically made the point about changes in medical technology. After all, such changes are responsible for many of these problems arising. Therefore, it is important to take account of the hon. Gentleman's point as we consult on these proposals.

Mr. David Hinchliffe (Wakefield)

I welcome the Minister's statement, because the present law leaves many people wide open to exploitation and abuse. I hope that the steps that he has outlined will address that.

I should like to press the Minister on two issues. First, directly because of Government community care policy, a significant number of vulnerable people who live in the community may previously have been in various kinds of institutional care. Has the Minister, in conjunction with his colleagues in the Department of Health, looked at the possibility of updating the guardianship regulations, which date back to, I think, 1959, to bring them into line with the current situation? Secondly, bearing in mind the fact that, through the privatisation of community care, more and more vulnerable people are in the care of private businesses, has he had the opportunity to look at supervising the financial circumstances of people who are in private care homes? I cast no aspersions on the many private care homes that offer very good care, but sometimes things have gone badly wrong.

Mr. Hoon

I am grateful to my hon. Friend for his considered observations. Guardianship regulations are not the direct responsibility of my Department, but my hon. Friend the Under-Secretary of State for Health, who is responsible for such matters, will have heard his comments, and I am sure that he will give them appropriate and careful consideration.

I realise that there are concerns about the circumstances in community homes, which must be investigated from time to time. The Green Paper contains a proposal to give social services enhanced powers to investigate the circumstances in which people, especially the elderly, are kept. I should be grateful if, in due course, my hon. Friend would write to the Department expressing his concerns in greater detail, so that his views can inform our decision making in this area.

Miss Ann Widdecombe (Maidstone and The Weald)

I am grateful to the hon. Gentleman for his considered exposition of this matter and for his consultation document. The gratitude that I felt when he announced unequivocal opposition to euthanasia was somewhat attenuated when he announced an exploration of living wills and the extension of enduring power of attorney to cover health decisions. Those two measures added together make me uneasy.

The Minister made a comparison between people who are of sound mind, who make a decision whether they will accept medical treatment, and people who are not of sound mind and have made that decision in advance. There is a huge difference. People who decide to consent to or refuse treatment have a specific medical problem of which they are fully aware, and the specific medical treatment and possible outcomes have been explained to them—it is a very specific decision—whereas a living will, by definition, is vastly more general and cannot cover that.

What would happen if two people were in hospital beds side by side, one of whom had made a living will and one of whom had not? A different law would apply to each of them.

Mr. Hoon

I am grateful for the right hon. Member's support for the considered view that I set out. The nature of the problems makes it necessary to examine whether there is an argument for legislation on advance statements or for reforming existing powers of attorney. Examining the problem in a considered way allows us to discuss possible legislative solutions. I take on board her point about comparing specific indications with the more general instructions that may be contained in an advance statement. It is important for treatment to reflect the needs and concerns of the individual.

The right hon. Lady's example of two patients side by side in a hospital ward does not necessarily cause me any difficulty. It is right for the doctors or authorities to take account of the specific indications of one patient, whereas the general intentions of the other patient are a matter of interpretation. That causes no difficulty, because a different approach can be taken according to an individual's particular circumstances. What runs through the Green Paper above all else is our absolute commitment to seeking to give effect to the intentions of an individual. I am sure that the right hon. Member and I agree on that.

Mr. Andrew Dismore (Hendon)

I welcome my hon. Friend's comments. The Court of Protection has been doing a very good job with personal injury and accident victims, and I am pleased that we are considering extending its role. Equally, however, it does not come cheap, and there have been arguments in personal injury claims about who is responsible for Court of Protection costs. If there is to be a review, and if it is to go wider and potentially increase legal costs, will he assure the House that the costs of pursuing civil justice will be taken into account in the review, and, specifically, that costs will not be passed on to accident victims?

Mr. Hoon

I am aware of the concern about costs. Anxiety about extending the court's jurisdiction to cover issues of personal welfare, health, property and finance is addressed in the Green Paper. It is important that sufficient resources are available to ensure that decisions can be made in those more sensitive areas, and we are consulting on the matter. I am grateful for my hon. Friend's observations. I think that it is important, however, that we try to establish a single court jurisdiction, not only to cover questions of property and finance but to deal with the wider range of issues affecting particularly the elderly.

Dr. Julian Lewis (New Forest, East)

The Minister will have noticed the non-partisan way in which Conservative Members have responded to his suggestions on greater protection for people who suffer mental incapacitation. Is he willing to consult and make representations to his colleagues in the Department of Health, so that a similar non-partisan approach is taken to my own private Member's Bill, which will be debated on Friday morning? I hope that my Bill receives a Second Reading—although that seems unlikely—as it proposes providing greater protection for people who suffer acute episodes of mental illness.

Mr. Hoon

Above all else, this is not a party political issue, and I am grateful for the hon. Gentleman's observations on that matter. As the Under-Secretary of State for Health is in the Chamber, I am sure that the hon. Gentleman's words will be taken into account.

Mr. Piara S. Khabra (Ealing, Southall)

You, Madam Speaker, know that, a few years ago, I introduced the Voluntary Euthanasia Bill. There was much opposition to it not only outside but inside the House. The House is a conservative body, and it either does not accept changes in the law or takes a long time to make such changes. That has been the House's history. Similarly, people are not yet prepared to accept that individuals require freedom. Does my hon. Friend accept that—although we talk about many types of freedom in the House, and our new Government are prepared to give more freedom to the individual—voluntary euthanasia is the only freedom that is not available to any individual? However, the Green Paper is a step forward, and I fully support it. I welcome the initiative, and I hope that the House will accept it.

Mr. Hoon

I have made it clear that the Government are prepared to consult on almost every question in the Green Paper, save for the one of euthanasia.

Mr. Paul Burstow (Sutton and Cheam)

Will the Minister take into account during the consultation period a situation in my constituency in which a family's application for British citizenship was successful, except for one member of the family? Under current rules, that family member was deemed not to be able to understand the British constitution, and was therefore not able to qualify as a British citizen. That is a monstrous situation, and it should be corrected through legislation which the Green Paper will make possible. Will he examine the matter?

Mr. Hoon

I have not heard of that situation, although I shall certainly examine it. If the hon. Gentleman will write to me or to a colleague in the Home Office, I am sure that, between us, we will be able to deal with that important matter.

Laura Moffatt (Crawley)

I thank my hon. Friend for his statement, which I very much welcome. As a nurse of some 25 years' standing, I believe that the medical profession will be very pleased with some of the Green Paper's proposals. We often get caught up in discussions about quality of life and assisting people to die, but we often forget—among all the legal talk—the issue of the quality of death.

I hope that my hon. Friend receives in the consultations many responses from people who believe that we should not only think about the subject in legal terms but ensure that people are able to die in the way that they wish and do not have to be assisted by medical people. I know that the public will be pleased to have the issue cleared up.

Mr. Hoon

I am grateful to my hon. Friend for her observations. I repeat the point I made a few moments ago. The important principle running through the Green Paper is that we should seek above all else to give effect to the intentions of individuals. Their intentions in relation to how they may choose to die are as important as how they may choose to live their lives.

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