Mental Capacity Act 2005 (Select Committee Report)

Baroness Warnock Excerpts

Tuesday 10th March 2015 Lords Chamber

[Baroness Warnock (CB)]

My Lords, the Government are right in their response to insist that the Mental Capacity Act is innovative, in that at the heart of the Act lies the so-called empowerment ethic. This is entailed in principle (3) of the Act, which states:

“A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success”.

This suggests that it is recognised that mental capacity, as my noble friend Lady Finlay said, is fluctuating and depends on when the person is being assessed. But when the time comes that a decision has to be made on a person’s behalf, then principle (5) comes into operation—namely, that the decision must be made “in his best interests”. Here, like my noble friend Lady Finlay, I find the troubles really begin.

The Government apparently agreed with the committee that more social workers principally—but other people as well—needed to be trained to be assessors of best interest. Of course, this is very difficult because, even with the best training in the world, to make a determination of somebody’s best interest is to make a value judgment; and whatever the training, it remains true that the values of the person making the determination of best interest may be different from those of the person whose interest is in question. For example, it is perfectly possible that the person who is the trained assessor of best interest may think that it is always, or nearly always, in the best interest of a patient who is incompetent to stay alive. On the other hand, the patient himself, if he had been able to make a decision, may have disagreed with that and may have preferred to be allowed to die sooner rather than to live on in a state of incapacity, humiliation, distress and, of course, pain.

It cannot be overemphasised how slippery and evasive the idea of best interest actually is, and lawyers have long disputed—certainly since the Bland case, and probably before—what actually counts as best interest and whether, in the case of Bland, for example, he could be said to have had any interest at all, being in a permanent vegetative state. This is a huge difficulty that really cannot be brushed aside. We need more trained people. The notion of best interest must be addressed in a different way. This is what makes the question of advance decisions—although I infinitely prefer the new title that my noble friend suggested—a matter of enormous importance. Therefore, the question of so-called advance directives is central to the interpretation of the Act and what the Government propose next to do.

It is not only the public at large who are ignorant of, and therefore careless of, making such advance directives but, disgracefully, the medical profession and other professionals who will be involved with people trying to make such decisions. It is also true that these professionals, including doctors, are unwilling to discuss any such matter. I remember the acute embarrassment of my own then GP when I asked him to keep a copy of the living will, as it was then called, that I had made. He did not want to think about it.

In their response the Government were right to say that the royal colleges have a great part to play, particularly the Royal College of General Practitioners. The college will not like being told what it ought to do, but it has a duty to influence all GPs to keep in their surgeries information about how to make such an advance decision. This is genuinely a matter of urgency because, whatever the status is thought to be of an advance decision, it must be taken into account, at the very least, if it has been made properly, if it seems to be applicable and, most important, if it is known at the time of the patient’s deterioration, or first entry into hospital or care home, that he or she has made such a decision.

This is part of the difficulty. There must be an easily accessible register which shows who has or has not made such a decision. As my noble friend suggested, there must of course be a way in which the person, whatever his capacity, can show that he has made such a decision. Therefore one needs something like a donor card or a bracelet that he can wear to say that he genuinely has made such a decision. This will have to be formalised so that it is known to be genuine, and this will be backed up by the register. These matters are of enormous importance because the question of the early, well formed wishes of the person under consideration must be taken into account. After all, this is the heart of the Mental Capacity Act.

It is a rather fiddly little reform that must be taken and GPs are, whether they like it or not, at the heart of it. After all, their surgeries are absolutely stuffed with leaflets and instructions about what to do if you have got diabetes or a mad mother and so on, but not anything about how to record your wishes about your own care and your own decision to refuse treatment in certain circumstances. There is nothing about that at all and I honestly believe that most people do not know that they have, first, a right to refuse treatment and, secondly, that there is a way of making this known. This is the most important issue that the Government must address through general practitioners.

I entirely support what my noble and learned friend Lord Hardie said about the disappointment that it seems that only a forum will be set up. The word “forum” sends shivers down my spine because it means nothing except a talking shop with no powers that will finally wither away out of alienation and boredom.

[Baroness Finlay of Llandaff]

I listened with great interest to what the noble Baroness said. Will she clarify whether she agrees with me that a so-called best interest decision that leaves a patient in pain and distress is actually not a valid best interest decision because it is not in the interests of the person to be left in pain and distress? That decision would, therefore, be open to challenge?

[Baroness Warnock]

I entirely agree with my noble friend.

Social Action, Responsibility and Heroism Bill

Baroness Warnock Excerpts

Monday 15th December 2014 Lords Chamber

[Lord Faulks]

I will give the same answer that I gave in relation to the distinction between the Compensation Act and this Bill, which is that the Bill says that the court “must have regard”. That is a distinction. I said in Committee that there may well be an overlap between Clauses 2 and 4. I do not say that they are wholly distinct; they convey an accumulation of concepts which are readily understood, and a judge may find it possible to bear in mind both Clause 2 and Clause 4. That fact does not mean that Clause 4 cannot, in appropriate circumstances, serve a useful purpose.

[Baroness Warnock (CB)]

Before the noble Lord sits down, will he answer the question raised by my noble and learned friend regarding what exactly the word “heroic” adds to Clause 4? Could it not be left out? Intervening for the sake of saving somebody is surely enough. Is there any reason for having “heroism” or “heroically” either in the Title of the Bill or in Clause 4?

[Lord Brown of Eaton-under-Heywood]

Before the Minister answers that, the words that are completely surplus here are “acting heroically by”. Why can it not read, “was intervening in an emergency”? Can the Minister whet our appetite as to whether there is any scenario when you can intervene in an emergency and so on, within the meaning of this clause, without acting heroically? If not, for heaven’s sake get rid of it.

Assisted Dying Bill [HL]

Baroness Warnock Excerpts

Friday 18th July 2014 Lords Chamber

[Baroness Warnock (CB)]

My Lords, it seems to me obvious that the law has to be changed. We are often told that it works well, but the trouble is that Directors of Public Prosecutions change and the law is not stable. The guidelines are therefore not stable and uncertain. It is clear that we do need to change the law; that is what we are being offered in the Bill.

It is sometimes said by those who are hostile to the Bill that the number of people involved is very small and therefore those people who are suffering have to be sacrificed, as it were, for the sake of the common good and for the rest of society because of our attitudes to the dying and so on. However, it is not completely clear to me that the numbers are so small. They are certainly not particularly small at the moment as palliative care is not, alas, available to everybody. It has been estimated that there are as many as 30,000 bad deaths a year for those who have no access to proper palliative care. Even if the numbers were much smaller than that and even if palliative care were evenly distributed and easily accessible, it still seems to me very hard to say that we know people are suffering but they have to put up with it as any attempt to alleviate that suffering will adversely affect an uncountable number of other people who will be put at risk. That is the core of a great many of the arguments that we have heard.

On that point, the older one gets the more one is told that one is vulnerable. Of course, everybody is vulnerable as far as that goes, but there is one form of vulnerability that I do not fully understand. It is somehow thought to be wrong that people who are approaching death and are terminally ill should take into account the suffering, expense and misery they are causing to their family as they are being a burden. Of course, they are also a burden to the state. Why is it that this is thought to be a wrong motive, or part of a motive, for wanting to end one’s life when it is coming to an end anyway? I totally agree with Matthew Parris, who wrote in the Times on Wednesday that if he were terminally ill that would certainly be a large part of his motive for wanting to die. I completely agree. For all of one’s life up to that stage, altruism is regarded as rather a good thing, a virtue. If one sacrifices oneself in a modest way for one’s family, that is also thought virtuous. I do not understand why one should not be allowed to exercise that virtue at the very end of one’s life, and not have it assumed that this is an idea that has been put into one’s head by somebody else. It is not; it is there already.

Finally, there is a point that is quite difficult to make. People sometimes talk as though life were a kind of stuff, which perhaps has been given by God, but whether it has or not, it is a kind of stuff that is valuable in itself, rather like water. We might well be told to save water at all costs. There is no life whatever that is not lived by some living creature. If a person, a human being, has decided that his life has no value, that he does not like it and that it is hateful to him, then he and he alone is in the position to say whether it is valuable. I do not think there is such a thing, such a stuff, as life that is abstract and common to everybody. Everybody has his own life and values, each for himself.

Crime and Courts Bill [HL]

Baroness Warnock Excerpts

Tuesday 4th December 2012 Lords Chamber

[Lord Pannick]

My answer to the noble and learned Lord is that if the legal system is able to accommodate this type of problem—that judges regularly take time off to carry out other activities—then, like all other professions, it ought to be able to accommodate a female judge taking time off on a regular basis for domestic reasons. It remains to be seen whether allowing part-time judges to sit will result in more women judges at high levels. These powers are permissive, not obligatory, and no woman or man—although one anticipates that it is likely to be women who are so appointed—will be appointed unless it is practical.

My primary objection to these amendments is based on the factor to which the noble and learned Baroness, Lady Butler-Sloss, referred—which is the message that is sent out—although I arrive at a different conclusion. I suggest that it would be a very unfortunate message indeed for the law to confer an exemption for the senior judiciary from one of the most important means of enabling talented women to rise to senior positions in all professions. Watering down the part-time provisions in this Bill would wrongly suggest, wrongly, that the senior judiciary is not serious about doing all that it reasonably can to assist talented women to be appointed at senior levels. I hope that the noble and learned Lord will withdraw his amendment.

[Baroness Warnock]

My Lords, I had no intention whatever of entering this debate but it seems to me that there is quite a serious analogy here between the teaching profession at the top level and the legal profession. There is no doubt that in a school, particularly a boarding school, part-time members of the staff, although they are respected and have authority, are not regarded as the most senior, reliable and ready to sacrifice their time. They are not, in fact, of the same level of authority as the full-time members of staff. Nothing would be more destructive of the trust which the general public have in the senior judiciary than if the Supreme Court were divided among the “real” members and the “unreal” members—the part-timers who could not take on the really difficult and complicated cases.

I rely on this analogy strongly to support the amendment of the noble and learned Lord, Lord Lloyd, because I believe that, for one thing, it is quite uncertain that this provision would have the apparently desired effect of encouraging more women to come forward; and quite apart from that, it would have the disastrous consequence of dividing the Supreme Court between the top and the lower levels.

[Baroness Neuberger]

My Lords, not being a lawyer, I enter this debate with a certain amount of nervousness. However, I did chair the Advisory Panel on Judicial Diversity, and I support everything that my noble friend Lord Pannick said. I disagree with the amendment for one very important reason. I want to add to what my noble friend said one important fact which comes from the evidence that the panel took from individuals and various bodies when compiling our report.

You could not put a sheet of paper between the six members of the panel, one of whom was a Court of Appeal judge, in our clear belief that flexible working ought to be available to the most senior levels. We did not necessarily use the word “part-time” because we thought that there were other ways of doing it rather than the conventional two days on, three days off. When we spoke to women who were thinking about whether they should apply to the Judicial Appointments Commission to go to the High Court, we were told time and again that unless some form of flexible working was available, they would find it very difficult.

Crime and Courts Bill [HL]

Baroness Warnock Excerpts

Tuesday 30th October 2012 Lords Chamber

[Baroness Warnock]

My Lords, I hope that the Government will pay attention to everything that has been said today. There seems to be a total confusion about the meaning of the word punishment and the adjective punitive. The meaning of these two words has separated over the years. Punitive suggests something quite alien from the notion of punishment, which is what is handed down when someone has been convicted. We know that vengeance does not work and that punitive sentences are not necessary. The whole point of punishment is to prevent further offences. We know now that community sentencing does, relatively speaking, work in the way that short prison sentences do not.

I beg the Government to concentrate on what is intended by punishment and to go on the evidence that community sentencing, with good support from the probation services, can work and that this is the intention. The adjective punitive seems to me to be completely out of place in this discussion altogether. I believe that the Government must listen to what has been said today.

[Lord Elystan-Morgan]

My Lords, I agree wholeheartedly with the remarks made by the noble Baroness, Lady Warnock. In relation to the past 30 years or so, Governments of every hue must stand in the dock and answer the accusation that they went out of their way to curtail the discretion that otherwise would have been vested in a judge or magistrate. Practically all Governments have done that and some of them more shamelessly than others. I am sure that anyone who has served in the courts in a judicial capacity, however senior or however humble, must be very aware of that.

The proposal that the Government are now putting forward in relation to the punitive approach is one of the most far reaching in that context. If it should be the case, as I assume it to be the Government’s case, that one-third of community orders which are made without a punitive element according to their definition must in all cases be dealt with in a different way, save for a very minuscule minority that is exceptional, then it is a very far-reaching and drastic proposal.

I fully accept that the Government are talking not so much about punishment in the sense of the disposal of a case of a person who has committed a crime but about something else, which connotes the idea that the experience of the defendant should be painful. My Latin is not all that good but does the word punishment not come from punitas? Is punitas not one and the same thing as pain? It is poen in Welsh and pain in English. Is that not really what the Government are after?

However, I think that the argument put forward by the Government, which has been described as offensive by the noble and learned Lord, Lord Woolf, and alarming by the noble and learned Baroness, Lady Butler-Sloss, is highly offensive. The 2003 Act had a vast range of community disposals. In many ways, they were imaginative, flexible and double-banked. The sentencer had a huge armoury at his or her disposal.

As I understand it, the Government are now saying that that failed to achieve its purpose. The people who were charged with imposing sentences missed the whole point. At some time after 2003, tens of thousands of sentences every year which should have involved a punitive element did not achieve their purpose because that element was missing. That statement is either correct or incorrect. If it is correct, it must mean that many people sat in judgment as magistrates, circuit judges and recorders who should never have been there. They were missing the whole point. However, if that statement is incorrect, it is one of the most unjust indictments of the administration of justice that there could ever have been. It is one or the other.

I ask the Government: where is the evidence that in tens of thousands of cases, year by year, at some point in time after 2003, that has been happening? I feel it is a policy and a gesture that is cosmetic rather than real and intended to give the impression of toughness. The greatest toughness to my mind that can be achieved in relation to the administration of justice is doing that which is right, that which you know to be just and that which you consider to be proper by society, irrespective of whatever prejudices tabloid editors might have against you. That is the toughness that the Government should seek to achieve.