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Baroness Knight of Collingtree: My Lords, in giving brief support to the amendment, I point out that earlier the noble Baroness, Lady Finlay, spoke of the distress caused in hospitals when—this has been reported many times—the food that a patient needed was placed too far for him or her to reach to eat it. Then the nurse would return later and say, "Oh, you're not hungry then, Mr Jones", and take it away. That is why many of us have received letters. Examples by the score have come to many noble Lords who are involved in the issue of health care. I hope and trust that the amendment will relieve that dreadful occurrence.

Baroness Andrews: My Lords, the noble Baroness's amendment is similar to one that we discussed in Committee last week, but the scope has been changed. She seeks to impose on all those providing nursing care for a patient a general duty to offer appropriate sustenance to that patient.

I shall reinforce briefly some points that I have made as the Bill has been debated in your Lordships' House. I cannot restate strongly enough that poor and neglectful care of patients should not happen. Failing to provide nutrition and/or hydration that is appropriate to a patient's clinical condition and nutritional needs is contrary to established acceptable practice, and, if amounting to gross neglect, would be a criminal offence.

The amendment seems to restate established good practice but is now selectively addressed to those providing nursing care. It is not addressed to all healthcare professionals, including doctors, who would be involved in initiating invasive methods of nutrition and hydration, and pharmacists and dieticians, who would be involved in providing and monitoring intravenous and intra-gastric nutrition. The clause could, however, encompass lay carers and thus impose new and possibly onerous duties on those close to a patient who may be nursing a relative at home.

The Bill already provides a definition of "sustenance":

However, it does not define what is appropriate. That is difficult enough for professional carers to decide but will often be impossible for lay carers. It is unclear what that means for a nursing or lay carer who may not be qualified to initiate, or possibly to administer, the more invasive methods of providing sustenance.

The word "offer" is not defined here or in the rest of the Bill, but the use of the word suggests that the amendment is about patients who are in a position to refuse. Where a person is not in a position to consent to treatment, or to refuse an offer, the normal rules apply and those caring for them must act in the person's best interests. If, as the end of life is reached,

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it is not appropriate to offer increasingly invasive methods of delivering sustenance, those caring for the patient do not have to make the offer.

I conclude by restating an observation that I think I made at Second Reading—it now seems a very long time ago. The discussions that noble Lords have had over many hours have reinforced how difficult it is satisfactorily and comprehensively to encapsulate subtle healthcare concepts, which require compassion and discretion in delivery in robust, unambiguous and defensible legal English. I recognise the noble Baroness's concerns in introducing the Bill. However, it would be worth while if we all reflected on whether there is a need for legislation in such a sensitive area. One could argue that the area is more amenable to the detail and subtlety that professional guidance and good practice can deliver, and where safeguards against transgression already exist in law.

The Bill has allowed many related issues to be aired in this House. It has been very valuable in that sense. However, at times, there has been a muddling of the Bill's intentions with general concerns about the quality of care available to elderly patients and patents who are dying under NHS care.

The Government believe profoundly in the fundamental principles underlying the inception and continuation of the NHS as it provides for elderly people—high quality care available to all who need it and free at the point of delivery. We have invested a great deal in that commitment. As we conclude this stage of the Bill, it is important to bear in mind the importance that we attach to the quality of care for elderly people, no matter what their circumstances.

Lord Joffe: My Lords, I support the intention of the amendment, but, like the Minister, I am concerned about the wording. Perhaps I may take the opportunity to explain to the noble Baroness, Lady Knight, that I do not seek to ensure that patients get "done in". I seek to assist patients who wish to die to do so with dignity. I refer the

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noble Baroness to the judgment of the noble and learned Lord, Lord Hoffmann, from which I quoted and in which he dealt at some length with the use of emotive language in discussions of such seriousness.

4.15 p.m.

Lord Brennan: My Lords, I rise briefly to raise a point advanced by my noble friend the Minister, which is to stress how careful we must be in dealing with matters of this sensitivity. That is not a reason why the House should decline to deal with matters of public interest, because in the House of Lords case of Bland, all the Law Lords said that it was a matter for Parliament, and at least one, the noble and learned Lord, Lord Mustill, said that the matter was of such importance for Parliament that it could not properly be left to the exercise of judgment by the medical profession. That was not an expression of a lack of confidence in that profession, but an expression of the belief that matters of this gravity must be determined by the legislature and not individual professions alone.

It would be unfortunate if our senior court recommends this House to consider these matters and we finish up referring it back to the very medical profession that brought the Bland case to the House of Lords in the first place. That would be a long circular journey since Bland.

Baroness Finlay of Llandaff: My Lords, I am most grateful to all noble Lords who have spoken. I am particularly grateful to the Minister for clarifying potential complications that may arise in the wording of the amendment. When I spoke previously, I had hoped to clarify that nursing was to be used in the broadest sense, not simply a narrow sense. It therefore leaves me with somewhat of a dilemma in terms of the wording of this amendment. However, I feel at this stage, given the possibility of tidying up the wording at Third Reading, I will press this amendment now.

On Question, amendment agreed to.

        House adjourned at seventeen minutes past four o'clock.

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