Palliative Care Bill [HL]

My Lords, I thank the noble Baroness, Lady Finlay, for introducing this Bill. Patients who are dying should have access to the same attention and standard of healthcare as all other patients. This access should be provided equitably to all groups in society. That was made clear in the powerful and emotional speech of my noble friend Lady Gardner, which, I, too, will remember. Most speakers so far have supported the Bill. I support the aims of the Bill but suspect that the Government will be reluctant to accept legislation on the provision of specific services. The General Medical Council supports the aim of ensuring that adult patients nearing the end of their lives should have access to high quality palliative care, both in hospital and in community settings, regardless of their diagnosis. Thirteen years ago, I was a member of the House of Lords Select Committee on Medical Ethics, which was appointed to consider the ethical, legal and clinical implications of a person’s right to withhold consent to life-prolonging treatment and the position of persons who were no longer able to give or withhold consent. One of the many conclusions that we reached was that resources for healthcare are not and can never be infinite. Healthcare teams should not be required to make decisions relating to resources in the course of day-to-day clinical care of individual patients. Their concerns should be for that individual’s welfare. Decisions about treatments which society can or cannot afford should be made elsewhere than in the hospital ward or doctor’s consulting room on the basis that such treatments as society wishes to fund must be made available equally to all who can benefit from them. We recommended that high quality palliative care should be made more widely available and that research into new and improved methods of pain relief and symptom control should be supported. The training of healthcare professionals should do more to prepare them for the difficult ethical responsibilities which they carry by giving more priority to ethics, counselling and communication skills. Many members of the committee believed that a solution to euthanasia was a development and widening of the hospice service. We visited different hospices and were tremendously impressed with the facilities for and the treatment of patients. Although in 1994 there were nearly 200 centres working with many more community and home-care teams, it was suggested that hospice care was not available to the vast majority of dying patients. The committee thought that there should be further research into pain relief and symptom control so that the standard of palliative medicine that many of us had seen should be available in hospitals and the community throughout the country. The Conservative Government’s response to this part of the report was described as timid and, although stating a determination to see good quality care, the Minister declined to recommend any increased funding for palliative services. In his reply to the recent debate on 31 January, the noble Lord, Lord Hunt, accepted the points made about the need to expand palliative care and indicated that the new end-of-life care strategy under the leadership of Professor Mike Richards would set a framework and would ensure that good quality palliative care is more widely available. I look forward to his comments on the membership of that group, as pointed out by the right reverend Prelate. As advances in medical science lead to new technology and drugs, decisions about life and death become more complex. The ability to prolong life can now subject the terminally ill to a dependence on technology which is stressful for patients, their families and healthcare professionals. Misconceptions among medical staff can lead to under treatment and a hesitancy about providing the necessary degree of pain relief for fear of drug tolerance or shortening the patient’s life. I am grateful for the briefings that I have received from various organisations—the National Council for Palliative Care, Help the Hospices and the General Medical Council, to name but three. They all support the noble Baroness’s initiative, believing that the Bill will strengthen and extend the provision of palliative care. The GMC welcomes the Bill as it coincides with its published guidance, Good Medical Practice, and its planned review of standards expected of medical graduates in order to gain entry to the medical profession. As the noble Baroness, Lady Finlay, has said, it has promised to ensure that the themes of this debate are included in the review. My noble friend Lord Patten suggested that most of the changes in developing palliative care have been in relation to cancer, but of course it applies to those with other conditions. Non-malignant diseases, including circulatory, respiratory, neurological and dementia are responsible for many more deaths. Palliative care should be developed for all those who need it, including all terminal illnesses. It is still not a mainstream service and inequities persist. I hope that this Bill, or perhaps the discussion we have on this Bill, will be part of the development process.