Medical Treatment (Prevention of Euthanasia) Bill — Consent of the Director of Public Prosecutions — 14 Apr 2000

The bill sought to prevent intentional killing of a patient by act or omission. It was prompted by the Bland judgement which allowed doctors to withdraw food leading to the death of a patient. At this point, the general principles of the bill had alread been agreed. The fine detail had been discussed in committee and the bill was now coming back to parliament. Those voting aye in the division were voting for the bill.

As amended in the Standing Committee, considered.

Brought up, and read the First time.

I beg to move, That the clause be read a Second time.

Madam Speaker: With this it will be convenient to discuss the following: New clause 11-- The Attorney General's consent (No. 2) --

The Government recognise that the current consent requirements are in need of reform and agrees with the Law Commission's view that a consent provision must attach to a particular offence not to a particular defendant or class of defendants.--[ Official Report , 22 November 1999; Vol. 339, c. 23W.]

We considered whether a consent requirement would be justified not merely in respect of certain offences but also in respect of other offences when they are allegedly committed by certain defendants--the reason being that such defendants if innocent, would suffer particularly serious harm in the event of a private prosecution. The only such case that we have been asked to consider is the question of the prosecution of doctors for manslaughter.

The starting point must be to bear in mind the strength of feeling understandably and inevitably caused by fatal accidents, and we appreciate the intense pressure that can be brought to bear by relatives of the deceased in seeking a prosecution. An acute illustration of this is said to arise when a person dies in hospital or where the relatives of the deceased believe that the person died as the result of some professional act or omission of the doctors. As we pointed out in the consultation paper, it had been suggested to us that criminal prosecutions, even if subsequently dropped before proceedings have concluded, would be likely to cause irreparable damage to the reputation of a doctor with the result that his or her career would be placed in serious jeopardy. On the assumption that this was correct, this raised the issue of whether, in those circumstances, consent should be required before doctors could be prosecuted for manslaughter.

a few respondents thought the introduction of such protection, explicitly nor implicitly, should be limited to a specified class of persons predominantly those in the medical profession. The Recorder of Bristol thought the category should be restricted to professionals who were forced to make life and death decisions in the operating theatre, while Longmore J--

gave as examples doctors, nurses and possibly other paramedical staff but pointed out the class should be fairly narrowly defined.

The Medical Defence Union asked for consideration to be given to other health-care workers whose position was similar to doctors and who could only work effectively in a climate of trust and confidence.

we conclude that it would not be appropriate to depart from the fundamental principle so as to require consent for prosecutions of doctors for manslaughter--

the absence of any evidence that the working lives of doctors . . . have been substantially damaged

pursue one simple objective: to restore the integrity of the fundamental principle of the law of murder. That is exactly what it does.

to try to restore the integrity of the fundamental principle of the law of murder and to make doctors responsible in law for their purposes in deciding on treatment of their patients.--[ Official Report , 28 January 2000; Vol. 343, c. 689-691.]

the boy to be starved.

a person who aids, abets, counsels or procures the suicide of another.

no proceedings shall be instituted for an offence under this section except by or with the consent of the Director of Public Prosecutions.

to restrict prosecutions in circumstances where a law has, necessarily, been drafted in broad terms, thereby creating the risk that it would catch those who had not offended against the spirit of the legislation.

The Franks Committee was "in doubt" that there was widespread unease amongst those "outside governmental and Parliamentary circles" about the Attorney-General carrying out both political and quasi-judicial functions.

This Act shall give rise to liability in tort only.

only on indictment in the Crown Court.

the press and public may be excluded from all or part of the trial in the interest of morals, public order or national security in a democratic society, where the interests of juveniles or the protection of the private life of the parties so require, or to the extent strictly necessary in the opinion of the court in special circumstances where publicity would prejudice the interests of justice.

The acute unease which I feel about adopting this way through the legal and ethical maze is I believe due in important part to the sensation that, however much the terminologies may differ, the ethical status of the two courses of action is for relevant purposes indistinguishable--

It shall be unlawful for any person responsible for the care of a patient to withdraw or withhold from the patient medical treatment or sustenance if his purpose or one of his purposes in doing so is to hasten or otherwise cause the death of the patient.

lawfully discontinue all life-sustaining treatment and medical support measures.

No person shall publish any material which is intended or likely to identify--

(a) any patient

shall give rise to liability in tort only.

to benefit the patient by restoring or maintaining the patient's health as far as possible, maximising benefit and minimising harm. If treatment fails, or ceases to give a net benefit to the patient (or if the patient has competently refused the treatment) that goal cannot be realised and the justification for providing the treatment is removed. Unless some other justification can be demonstrated, treatment that does not provide net benefit to the patient may, ethically and legally, be withheld or withdrawn and the goal of medicine should shift to the palliation of symptoms.

It shall be unlawful for any person responsible for the care of a patient to withdraw or withhold from the patient medical treatment or sustenance if his purpose or one of his purposes in doing so is to hasten or otherwise cause the death of the patient.

If I had used the word "intention" in clause 1, it could arguably have been claimed that we wanted to outlaw anything that would have had the side effect or double effect of hastening or causing death. That would, of course, be an intolerable restriction on medical care.

The definition of purpose may be legally obtuse, but it is understood in common law and in the understanding of people. We sometimes judge things legalistically. Everybody understands what purpose means and is. I have said at length that it is equivalent to intent.--[ Official Report, Standing Committee C , 16 February 2000; c. 41-42.]

A concept formed by directing the mind towards an object.

the act or fact of intending; intention, purpose . . . A design, a project. Assiduous effort; a design or project . . . intent observation.

I do not believe that doctors should under any circumstances be allowed intentionally to kill their patients, whether by action or omission, and they are not allowed to do so under the present law.

the intention to bring about the patient's death is there.

Question put, That the Question be now put:--

The House divided: Ayes 96, Noes 10.

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