Conscientious Objection (Medical Activities) Bill [HL]

Lord Dubs Excerpts

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

[Lord Dubs (Lab)]

My Lords, I first had the pleasure of meeting the noble Baroness, Lady O’Loan, in Northern Ireland many years ago, and I was very impressed by the work she did there and the excellent way she contributed to the peace process and decent life in Northern Ireland. It is therefore with some regret that I have to differ from her on this occasion. I feel pretty bad about that, but I feel I must do so. She was such an important figure in those years in Northern Ireland.

Of course we all agree about the right to conscientious objection. It seems to me that we are simply debating where to draw the line. There is no real point of principle here. I think the current provision for conscientious objection in medical practice has just about got the balance right between healthcare professionals’ moral beliefs and patient freedom. I fear that this Bill would tip the balance in the wrong direction, away from the rights of patients. That is the basis of my objection. I do not think the case has been made out for the Bill, at least, not to my satisfaction.

There is one particularly important point. There is nothing in this Bill which would oblige the objecting healthcare professional to refer a patient’s case to another professional who did not have an objection. In other words, if a doctor, nurse or whoever is unhappy about being asked to carry out a procedure or form of treatment, surely they should be able to do what has traditionally be done, which is to say, “I can’t do this, but I’ll refer you to somebody else who can”. That is an enormous gap in the Bill. I do not think I have misread the Bill; it is not there, and that is unfortunate.

The Bill would significantly widen the scope of conscientious objection. It would increase the number of medical procedures to which conscientious objection would apply under the law. It would broaden the range of professionals to whom it would apply. For example, Clause 1(2) states:

“‘participating in an activity’ includes any supervision, delegation, planning or supporting of staff in respect of that activity”.

That participation may be so peripheral to the activity itself that it is extending the principle of conscientious objection too far. I much prefer the comment of the noble and learned Baroness, Lady Hale, about it having to be hands on, but even if we feel the noble and learned Baroness was too narrow, the Bill goes far too far in the subsection I read out because we are talking about supervision, delegation and planning.

Let me spell it out. For example, you might have a palliative care clinical nurse specialist supervising the specific care needs of patients on an oncology ward, including those who may have refused life-sustaining treatment, such as chemotherapy. It is the right of patients who suffer from cancer to refuse chemotherapy, and I know some people who do. Surely that ought not to be within the ambit of the Bill. I could give many other examples. The rights of patients should not be forgotten in this way.

The Bill also seeks to expand the activities to which a healthcare professional could object. It is crucial not to distinguish between people starting treatment and people stopping treatment at a time of their choosing. We heard a very emotional speech from the noble Baroness, Lady Richardson, about her family circumstances. It seems to me that the right not to have treatment and the right to stop treatment are fundamental, and my fear is that this Bill would make that freedom less effective

Lastly, there are people who want to refuse life-sustaining treatment in advance because of the possibility of deterioration in their mental health condition. I fear that the Bill is silent on whether healthcare professionals can conscientiously object to enabling mentally competent adults to refuse in advance life-sustaining treatment which others may regard as necessary.

I regret having to object to the Bill, but I do. I think it would be to the detriment of patients and I do not believe it takes the argument of conscientious objection any further in a sensible way.