My Lords, I strongly support the amendments in the name of the noble Lord, Lord Steel, and others. I apologise to the Committee for not being here for Second Reading for various reasons. I was almost prevented from coming today, but I managed to struggle here. I have the utmost respect for the noble Baroness, Lady O’Loan, and for the reasons behind her Bill, but when I examined it I was immediately struck by what seems to be a conflict between, on the one hand, putting a patient’s best interests first and, on the other, the doctor’s conscientious objection to providing certain treatments. I should perhaps explain how I came to that concern and why I support these amendments by expressing my interests.
I was in the distant past dean of the faculty of medicine in Manchester—a faculty, incidentally, that included nursing and dentistry as well as medicine—and then president of the Royal College of Physicians. In both roles, I was at pains to instil high standards of care in our students and trainees, but I must say that I was brought up short later when I became president of the Medical Protection Society. In that role, I had to face doctors who had failed their patients in one way or another—quite a shock to the system after what I had been trying to do until then to ensure ethical and moral behaviour, focusing heavily on putting the patient at the centre of everything that we do as doctors.
1.15 pm
When I was in clinical practice, I was aware that if a patient asked me to give them some treatment that I considered inappropriate or likely to be harmful—that is, not in the patient’s best interest—I could refuse. I could refuse to be forced into it against my better judgment. I was fortunate never to find myself in that sort of conflict with a patient, once we had discussed the options and the reasons why I objected. Above all, everything I tried to do was in the patient’s interests as far as I could judge them, and I tried to follow the dictum: first, do no harm. It is this element—putting patients first—that bothers me about the Bill and why I believe the amendments are so important.
As a practising doctor, I was not personally involved in decisions about abortion, human fertilisation or embryology, but I was often involved in decisions about end-of-life care. I hasten to say that not all my patients ended their life under my care—some had the good fortune to survive—but end-of-life care always involved difficult decisions. The most pointed decisions are, first, about stopping treatments that are thought futile and, secondly, whether life-support systems should be turned off. Here, there is no way around the basic need to consider what is in the patient’s best interest.
It is relatively easy if the patient tells you that they do not want any further treatment. To continue trying to give a treatment that the patient objects is tantamount to assault, in my mind. At the other end of the spectrum, however, where patients are unconscious, perhaps on life support and with a terminal illness from which recovery seems impossible, it is vital to have a full and open discussion with close relatives and everyone else concerned with that patient’s care. Of course, the diagnosis has to be clear. It has to be clear that recovery is unfeasible or that brain death is proven beyond doubt, but once that is so, everyone concerned has to feel that they have been heard and explanations have been carefully and sympathetically made.
It is perfectly reasonable for a doctor to have conscientious objections to providing the treatment outlined in the Bill, providing of course that patients do not suffer as a consequence, especially when it is likely that patients do not share those objections. I have, I think, shown that it would be objectionable for a doctor to be forced into acting in a way that conflicts either with his or her better judgment or, as covered by the Bill, because of their religious or other basic beliefs. However, we have two perfectly good Acts of Parliament—the Abortion Act 1967 and the more recent HFE Act—that ensure that doctors will not be forced into doing anything that they find morally unacceptable. It goes too far to suggest that those doctors can or should prevent anyone else carrying out such treatments where it is in the patient’s best interest to have them.
That is why it is quite inappropriate to include in the Bill such wide powers for an objecting doctor to be able to prevent others providing treatments to which they personally object. Indeed, if it is the patient’s interest—which comes first—such doctors are currently under an obligation to refer their patients to someone else, particularly if by not doing so that patient is likely to come to harm. The first “do no harm” dictum
of Hippocrates really should come first. That is why I support this amendment, which specifically limits conscientious objections to the doctor with hands-on responsibility, and no one else who may care for the patient. Many of the amendments we will shortly consider simply emphasise that point. Together, they make it difficult to understand why we need the Bill at all when we have two other Acts that cover the difficulty of conscientious objection so well.