Conscientious Objection (Medical Activities) Bill [HL]

Lord Dholakia Excerpts

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

[Lord Dholakia (LD)]

My Lords, as a precursor to this debate I have read with great interest the article from the noble Baroness, Lady O’Loan, in the House Magazine. I declare an interest as a member of the All-Party Parliamentary Group for Choice at the End of Life.

I am concerned about the implication of this Bill, particularly as the existing medical and legal regulations work well, striking a sensible balance between allowing healthcare professionals to conscientiously object without abandoning their patients and causing distress to patients and their families.

I support the right of healthcare professionals to refuse to participate in a hands-on capacity in specific medical activities and I am confident that this right to conscientious objection is well established within current medical laws and protocols. I am concerned that this Bill, which aims to expand existing sensible provisions on conscientious objection as it relates to the withdrawal of life-sustaining treatment, will have a detrimental effect on comprehensive, person-centred care currently provided by multidisciplinary teams. In some situations I fear the Bill, if enacted, could lead to patients being abandoned by healthcare professionals. This could also have a detrimental impact on the families and loved ones of patients approaching the end of life at what is an already difficult time.

The Bill would undermine the Mental Capacity Act 2005. Existing legal provisions and guidance on conscientious objection strike the right balance between respect for healthcare professionals’ beliefs and ensuring the best interests of the patient. As an example, I point out that the Bill threatens to undermine the entirely reasonable provisions of 2007’s Mental Capacity Act 2005 Code of Practice, which is very clear that healthcare professionals do not have to do something that goes against their beliefs, but they must not simply abandon patients or cause their care to suffer, so should refer their patient to another colleague willing to participate.

I am not aware that the National Mental Capacity Forum has expressed a view on this Bill but I hope that organisations with an interest in protecting and advancing patients’ capacity to make decisions over their health and care will ensure that conscientious objection should not become a limit on patients’ ability to decide for themselves.

The Bill would negatively impact patients and their families. Let me explain. Providing care for those approaching the end of life can be challenging for healthcare professionals but the well-being of the patient must be the first concern. If the patient has capacity and wishes to do so, they are entitled to make their own decision about consent or refusal of treatment and should be supported to do so. Equally, under the Mental Capacity Act 2005 in England and Wales, if the patient has made an advance decision to refuse treatment or appointed a lasting power of attorney for health and welfare, their decisions or those of their attorney must be respected.

Those decisions should be respected in a timely manner. It would be completely unacceptable for a patient approaching the end of life to have to continue treatment they did not want while awaiting transfer to a palliative care or other team of healthcare professionals that did not object to their decision; and it would be completely unacceptable for the patient’s family to have to watch them receiving this unwanted treatment, but I am afraid that that could be the implication of the Bill.

Let me cite a couple of examples relating to this argument. The cases relate to Mrs N and Paul Briggs. Decisions on withdrawing treatment for people who are in a persistent vegetative or a minimally conscious state—prolonged disorders of consciousness—are necessarily complicated. In several of these cases—such as that of Paul Briggs, the policeman who suffered a brain injury in a car crash on his way to work, and Mrs N, a woman who was in a minimally conscious state over a period of many years due to advanced multiple sclerosis—it has taken huge efforts by their family members, sometimes in the face of objection by professionals, to get their cases heard by the Court of Protection.

Mrs N’s daughter told the judge who eventually heard her mother’s case:

“I cannot emphasise enough how much the indignity of her current existence is the greatest contradiction to how she thrived on life and, had she been able to express this, then without a doubt she would”.


Similarly, before the courts decided on Paul Briggs’s best interests, his wife Lindsey wrote:

“I love my husband but he is dead in all but his body. I don’t know when I will ever lay him to rest in peace. That’s a limbo no one should be in”.


It must have been incredibly difficult for them to see their loved ones suffer over a period of years, receiving treatment that they did not believe they would ever have wanted. Even when the Court of Protection has decided that withdrawing treatment is in the best interests of the patient, some families have to struggle to find healthcare facilities where the staff members do not conscientiously object to their decision.

Let me conclude by saying that the existing rules allow for any healthcare professional to conscientiously object to withdrawing life-sustaining treatment as long as they find another healthcare professional to take over their patient’s care. I fear that the Bill will impose an additional unnecessary strain at an already distressing time on people at the end of life and on their families. It would also run counter to the principles of patient-centred care. I hope that the Bill will be substantially amended in Committee.