My Lords, I have listened with great care to the various speakers who have articulated their views on this group of amendments. It has been a very profound and interesting debate and I thank all contributors.
As I said at Second Reading, the Bill does not seek to limit access to abortion. It could never result in a patient who had expressed a wish not to be resuscitated in an advance decision being forcibly treated. It would not result in treatment, hydration or nutrition being withdrawn from someone who wanted to live. For the avoidance of doubt, it is only about enabling medical practitioners to withdraw from treatment which they perceive for moral or philosophical reasons, or for reasons of belief, to lead inevitably to death, whether of a living person or of an unborn child. It is not about doing things to patients; it is about some medical practitioners not having to do some things.
I want to allude for a moment to the various contributions on the subject of what the noble and learned Baroness, Lady Hale, said. I endorse what the noble Lord, Lord Alton, said, that Parliament could not have envisaged the way in which the abortion law would develop. The noble and learned Baroness, Lady Hale, chose the narrow meaning on the basis that it was more likely to have been in the contemplation of Parliament when the Act was passed. She acknowledged the existence of a broader interpretation. As the noble Lord, Lord McColl, very clearly said, we have the right, as a Parliament, to change things. I am suggesting that we need now to contemplate the situation in 2018, not the situation in 1967, so it is not about refusing
people access to treatment. There have been suggestions that it is about denying patient autonomy. A patient does not have and never has had the right to compel a particular practitioner to do a particular medical procedure. However, they have the right to a service and the right, if they want it, to a second opinion, and that must continue.
3 pm
Treasury statistics show that the NHS deals with over 243 million patients a year—1 million every 36 hours—which is an astonishing figure. It is a vast organisation, which undoubtedly has the capacity to provide reasonable accommodation for those of its medical practitioners who are conscientious objectors in these limited areas. The NHS, as the noble Lord, Lord McColl, again said, employs almost 1.2 million people. It is therefore possible to allow midwives and doctors who have conscientious objections to termination of a pregnancy to care for the 700,000 women who give birth in our hospitals in England and Wales every year, helping those for whom conception is difficult or seems impossible, as the noble Lord, Lord Winston, has done with such success over 70 years, and working in gynaecological departments, helping women who suffer from a huge range of gynaecological conditions, some of which are very disturbing and interfere with their ability to walk and move around freely, and so on.
We have a shortage of obstetricians, gynaecologists and midwives and, of course, nurses. Part of the reason for that is that people do not apply for jobs in these areas. I have heard this from many practitioners. The noble Baroness, Lady Thornton, suggested that I did not produce evidence. I suggest that she rereads my Second Reading speech, not least the reference to the inquiry that was conducted here in Parliament on conscientious objection to abortion and its consequence.
It has been suggested that in the context of management jobs, such as clinical leads, it is necessary to require that there be no right of conscientious objection because abortions must be scheduled, and so on. However, it is not quite as simple as that. I think we can agree that no one person, however brilliant they are, has absolute professional capacity in every area affected by their area of clinical responsibility. Solutions are possible—and exist, and are practised—to address any difficulties. So, for example, a clinical lead has deputies, and such a person might be the one to take responsibility for that area of activity, allowing the person who has a conscientious objection to abortion to withdraw, but to progress through their careers into management while providing a service in all the areas; for example, of obstetrics and gynaecology, to which I referred a minute ago, facilitating and enabling conception, care of pregnant mothers, delivery of those 700,000 births each year and the care of those suffering from gynaecological diseases and other conditions.
It would be most helpful if we could discuss further the amendments in this group to see whether we can agree how reasonable accommodation might be achieved or provided for and so improve the service available to patients while protecting practitioners. I think we can reach a situation, given the good will that has been
expressed in this House, by which we could ensure that services will not become difficult to access because of it, and that services will still be there.
There are some 60,000 abortions in the NHS each year; the rest are conducted in private clinics, so that number is actually a small percentage of the totality of the work of practitioners in obstetrics and gynaecology, where we have those 700,000 births a year and all the other work I have referred to. The Bill does not take away the duty of the NHS to provide services. That duty will remain. All that will be required of the NHS is reasonable accommodation for a limited number of people, which of course is recognised and accepted by all the royal colleges. Some of the amendments in this group seek to remove from protection all the proximate forms of assistance or co-operation, such as supervision, planning and delegation, through which a medical practitioner may be implicated very closely in the activity to which they conscientiously object. But, as has been said, supervising, planning or delegating the doing of X means making sure that X is done and, most importantly, that X is done right. The aim of the Bill is precisely to protect conscientious objectors from coercion through this type of involvement in matters intrinsic to the taking of life or the withdrawal of life-sustaining treatment.
Having listened carefully, I believe that as a Parliament and as a country we can afford and manage to provide protection to those for whom conscience makes activity designed to end life untenable. Forcing people to act against their conscience, leaving them in a position in which they never know when they will have to do something to contribute to the ending of life; accepting that hostility and exclusion are legitimate reactions to an avowed and profoundly held belief—for some a religious belief, for others a philosophical one—cannot be right. I have been told by Members of this House and many others of the ostracisation which can make life so very difficult for those who want to provide medical care to sustain and enable life, and to manage the dying of those who must die, with the greatest possible levels of palliative care. In a society that is proud of its historical contribution to the evolution of the fundamental British values of democracy, the rule of law, individual liberty and mutual respect, and tolerance of those with different faiths and beliefs, it is unacceptable if we do not have a proper, modern and appropriate law of conscientious objection.
In concluding, I urge those who have tabled these amendments to talk to us so that we can discuss a way forward that would meet their concerns As tabled, these amendments would not enhance the situation of all those who are regulated by the organisations in Clause 1(2)—we will come back to that important part of the Bill—nor would they enhance the experience of patients. Patients would still be able to accept the same services. It is possible to provide autonomy for patients and protect the conscientious objection of medical practitioners. They are not mutually exclusive—a recognition, perhaps, of the human rights of which the noble Lord, Lord Brennan, so eloquently spoke.