§ 3.57 p.m.
§ THE MINISTER OF STATE, HOME OFFICE (LORD HARRIS OF GREENWICH)My Lords, I should like to repeat a statement just made by my right honourable friend the Home Secretary in another place. The Statement is as follows:
"On May 23 I said that I would review the position regarding compulsory feeding and the traditional view that a prison medical officer would be neglecting his duty if he were not prepared to feed artificially a prisoner on hunger strike, if necessary against his will, in order to preserve his health and life. Distasteful and objectionable though artificial feeding is, it has been judged preferable to allowing the prisoner to die or his health seriously to deteriorate. I should like to pay tribute to the professional skill and compassion with which members of the prison medical service have discharged their responsibilites in circumstances which I know they have found difficult and distasteful.
1143 "The doctor's obligation is to the ethics of his profession and to his duty at common law; he is not required as a matter of prison practice to feed a prisoner artificially against the prisoner's will. Since there has been misunderstanding on this point, I think it is in the interests of prisoners, the medical profession and the public, that the procedures to be followed in future should leave no room for doubt.
"I am advised that the common law duty placed upon persons in charge of a prisoner is to take such steps as are reasonable in the circumstances of each case to preserve the health and the life of the prisoner. In making their decision in respect of any particular case they must have regard not merely to the dangers likely to flow from the prisoner's refusal of food, but also to those likely to flow from the process of forced feeding itself, if it is resorted to, and particularly if it is resisted.
"Accordingly, the future practice should, in my view, be that if a prisoner persists in refusing to accept any form of nourishment, the medical officer should first satisfy himself that the prisoner's capacity for rational judgment is unimpaired by illness, mental or physical. If the medical officer is so satisfied he should seek confirmation of his opinion from an outside consultant. If the consultant confirms the opinion of the prison medical officer, the prisoner should be told that he will continue to receive medical supervision and advice and that food will be made available for him. He should be informed that he will be removed to the prison hospital if and when this is considered appropriate. But it should be made clear to him that there is no rule of prison practice which requires the prison medical officer to resort to artificial feeding (whether by tube or intravenously). Finally, he should be plainly and categorically warned that the consequent and inevitable deterioration in his health may be allowed to continue without medical intervention unless he specifically requests it.
"I have discussed this subject with my right honourable friends the Secretaries of State for Scotland and Northern Ireland, who have decided that the 1144 procedures I have outlined will apply also in Scotland and Northern Ireland."
My Lords, that concludes the Statement.
§ 4.0 p.m.
VISCOUNT COLVILLE OF CULROSSMy Lords, we are very grateful for that Statement which has been repeated by the noble Lord. I am sure that everybody appreciates that hunger strikers come in different brands. There are those who wish to put up a minor demonstration and who refuse prison food and feed themselves from the prison shop. There are others who, for one reason or another, persist for a greater or lesser length of time, and there are some who persist as a matter of principle—probably a political principle—to the extent where life and health is very much at risk. I would echo, and I am sure that anyone who has had experience of the Prison Service would also echo, the obnoxiousness of having to deal with people who persistently and adamantly refuse food. It is not only the fully-trained prison staff who are involved; this is a matter which also has to be dealt with by hospital officers, and I join in the tribute which has been paid to those who have been involved.
This is a departure from the situation as we have known it before, and if I may I should like to ask the noble Lord two questions. First, has it been cleared with the medical profession that ethically they can do this without breaching the duty they owe to their patients, when their patients are people who are in prison? For it is most important that we should do nothing by an administrative decision of this kind to put any doctor in danger of prejudicing his professional integrity.
Secondly, although the noble Lord has mentioned what happens in common law, when I had this matter before me I was told that it was a matter also of prison rules and that there was something in the prison rules which required us positively to attempt to keep alive, whether officiously (as the old rhyme goes) or not. The noble Lord has not mentioned this and, therefore, I assume that the advice he now has is that no amendment to the prison rules is necessary. If that is the case, so be it, but so far as I am concerned—and I do not know how your Lordships feel about this—if we lay down these as ground rules, people who choose 1145 to go on hunger strike for a prolonged period, if necesary for political reasons, will in future do so at their own risk. I think that we should appreciate that they do it to some extent at our risk also, because there is the possibility of martyrs being made—though perhaps no doubt one could have a glut of martyrs, which puts the matter at a somewhat small premium. That is the position I would adopt, and if we are to do this then it is as well to say so plainly.
My mind moves on from the question of hunger strikers to those who have done this in the past and to the reasons why they are in prison. I have heard—and I hope this is not too far out of order—that there has been another very disagreeable bomb incident at the Tower of London rather less than two hours ago. I do not know whether or not there is any connection with Ireland here. I wonder whether the noble Lord could, in addition to answering my other questions, tell us something about this.
§ LORD WIGODERMy Lords, on behalf of my noble friends on these Benches, may I also thank the noble Lord for repeating the Statement, and raise three matters arising out of it. First, would the noble Lord agree that, with the abolition of attempted suicide as a criminal offence, there is no longer any legal obligation upon other people to attempt to preserve the life of those who are engaged in hunger strikes?
Secondly, would the noble Lord agree that the moral duty and the moral problems posed to prison officers and members of the medical profession have been excruciatingly difficult? Would they welcome the guidance given in this Statement, which is to the effect, as I understand it, that in future food is to be made available and it will be up to the individual prisoner to decide whether or not to avail himself of it?
Thirdly, without referring to any specific case—which would serve no useful purpose at this point—would the noble Lord bear in mind that where hunger strikes are embarked upon by a number of people for political purposes it is highly undesirable that they should be allowed to associate or to communicate with each other freely for the purpose of gaining mutual support and for increasing the propaganda value of their exercise?
§ LORD HARRIS OF GREENWICHMy Lords, I should like to thank both the noble Viscount and the noble Lord for their reception of the Statement. On the last point which was raised by the noble Viscount, concerning the deeply regrettable event at the Tower of London this afternoon, there was, in fact, an explosion just after two o'clock. No warning was received and 24 people, according to our latest information, have been injured—in quite a number of cases, I regret to say, quite seriously. Substantial damage has been caused. Of course, we shall keep the House informed on this matter so far as we can.
If I may now turn to the specific matters which have been raised, I welcome the note which has been struck by both the noble Viscount and the noble Lord. Taking first the specific questions put by the noble Viscount, we did, in fact, consult the Chairman of the General Medical Council on this matter, and the Statement made by my right honourable friend the Home Secretary in another place is consistent with the recent statement of views of the Central Ethical Committee of the B.M.A. Secondly, on prison rules, we have looked at this and it is our view that we shall not have to change prison rules, although we shall have to change the appropriate Standing Order relating to members of the medical staff; and that will be done. I think it is Regulation 104.
If I may now turn to the points raised by the noble Lord, Lord Wigoder, I rather agree with what he says on the point of attempted suicide. We have a different situation now from that which obtained at the time of the last recorded case just before the First World War, when there was a great deal of discussion. Secondly, he referred to the moral difficulties. These are indeed great, as my right honourable friend said in another place. The pressures on the medical staff have been very severe indeed in recent months and they have not been in any way lessened by some of the charges levelled against them from outside sources. Lastly, on the question of association of groups of hunger strikers, I take the point made by the noble Lord and I recognise the allusion to a recent specific case. This is something which must be looked at in the circumstances of the particular case.
§ BARONESS SUMMERSKILLMy Lords, I thank my noble friend for his Statement. I am sure that it will be welcomed by doctors throughout the country, because every time a prisoner is forcibly fed it involves a risk not only to the prisoner but also to the doctor, in respect of his whole professional standing. It is possible, of course, to make a mistake and it is very easy to do so if the prisoner is resisting forcible feeding. Therefore, it is only fair to doctors to recognise that they should be protected equally with the prisoner. This will afford them that protection which I believe they deserve.
§ LORD HARRIS OF GREENWICHMy Lords, I am very grateful for what my noble friend has just said. I think she has identified a most important point; namely, the risks involved when there is resistance to forcible feeding. As the House will be aware, on the last occasion certain directions had to be given as a result of the very substantial risks involved both to the hunger strikers themselves and to the medical staff.
§ LORD BROCKWAYMy Lords, I should like my noble friend to be aware that I appreciate both the human and the ethical issues which are involved here. Would he not agree that there is some distinction between forced feeding by tube when the prisoners resist—which is as horrible for the doctors as it is for their patients—and intravenous feeding, when it may be a medical duty to seek to save a life? Should there not be some distinction between those two operations?
§ LORD HARRIS OF GREENWICHMy Lords, with respect to my noble friend, who was of considerable assistance in this most recent publicised case, I regret I cannot see the distinction that he makes. A resisting prisoner can make in-traveneous feeding totally impossible. That is something we had to consider in this recent case.
§ LORD SEGALMy Lords, can my noble friend say whether all these cases of forcible feeding are treated in the prison hospital? What are the contrary indications against their admission into the prison hospital?
§ LORD HARRIS OF GREENWICHMy Lords, in the past I understand that in a number of cases people have been taken to the prison hospital. It seems 1148 that this has been considered to be the most appropriate place. In the future rather different rules will apply.