Conscientious Objection (Medical Activities) Bill [HL]

Baroness Meacher Excerpts

2nd reading (Hansard): House of Lords
Friday 26th January 2018 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I express my great respect for my noble friend Lady O’Loan but also my considerable concern about the likely consequences if this Bill were to reach the statute book. I also pay tribute to the extraordinarily moving contribution from my noble friend Lady Richardson, which for me says it all. The focus of my remarks will be Clause 1(2) and in particular the widening of the definition in that clause of the term “participation” in the treatment process. I will limit my remarks to the issue of withdrawing life-prolonging treatment at the request of the patient.

In this context, the issue today is the right of patients to decide when and whether to accept medical treatment. In the past, of course, it was assumed that doctor knew best and the patient should not have any say in what happened to them should they fall into the hands of the medical profession. But in recent years, a basic tenet of medical treatment has become the right of the patient to know about the side-effects of treatment and the consequences of non-treatment, so that they can make an informed decision about what they know is in their own best interest.

The centrality of the patient in treatment decisions is assumed throughout adult life—until the months before death. The General Medical Council makes clear the duties of medical practitioners in its guidance, Treatment and Care towards the End of Life: Good Practice in Decision Making, published in 2010. Importantly, the GMC makes it clear that a doctor must not refuse to withdraw life-prolonging treatment because of a conscientious objection without first ensuring that arrangements have been made for another doctor to take over. In other words, a conscientious objector can—fair enough—have a conscientious objection, but must not interfere with the ending of life-prolonging treatment if that is the wish of the patient. If it is the wish of the patient it is because it is in the best interests of the patient. The patient’s wishes must be paramount. Similar emphasis is placed on the patient’s right to decide in the Mental Capacity Act Code of Practice—which I believe my noble friend Lady O’Loan knows extremely well—and by the Nursing and Midwifery Council.

The provisions of this Bill will place an unnecessary additional burden on the medical professionals and others in our already drastically overstretched NHS. This worries me deeply, because we want patients to get the treatment that they want and deserve. If the GMC’s and other guidance is not fully complied with, the important needs of patients will not be met. The current law works well; as they say, if it ain’t broke don’t fix it. The law allows medical professionals to conscientiously object without abandoning their patients and without compromising the principles of person-centred care. Clause 1(2) of this Bill intends—as noble Lords know well after all these very good speeches—to extend the definition of “participating” in the withdrawal of treatment to encompass,

“any supervision, delegation, planning or supporting of staff”.

As other noble Lords have said, this is in direct conflict with the Supreme Court decision, delivered by the noble and learned Baroness, Lady Hale, that:

“‘Participate’ in my view means taking part in a ‘hands-on’ capacity”.


It is terribly important, I think, that a medical professional should not be required to do something directly contrary to their conscience. I hope your Lordships will want to uphold the Supreme Court decision and, therefore, to reject this Bill. My noble and learned friend Lord Brown set out that decision in detail, which was most helpful.

I support the concern of the noble Lord, Lord Dubs, that this Bill also says nothing about whether healthcare staff could conscientiously object to helping mentally competent adults with their advance care plan, including clarifying situations where they would want treatment to be withdrawn. If that happened, it would have a swathe of further detrimental effects for patients. It is important for us all to try to put ourselves in the position of a dying person whose suffering has become unbearable and whose treatment is only prolonging a situation they find intolerable. The patient wants the ability to decide how much suffering they are willing and able to take. Can anyone really say that the patient should be denied that right?

Particularly vulnerable, if this law were passed, would be a terminally ill patient in a hospice who decided that they wanted treatment to cease, but whose charge nurse with management responsibility for their care had a conscientious objection to that patient’s decision. Would that charge nurse really be able to ensure that someone else took over their management responsibility? Would there be such a person? This law is dangerous. It would have a negative impact on palliative and hospice care. Terminally ill patients could be required to suffer more than they already do—people suffer enough—and, therefore, wrongly, in my view.

This is a complex issue, but I believe that the current law strikes a pretty good balance. I therefore cannot support this Bill.