The Mental Capacity Bill passed its third reading in Parliament last night - after an eleventh hour concession helped limit a revolt by Labour MPs. Lord Falconer, the Lord Chancellor, promised to change the Mental Capacity Bill in the Lords to clearly outlaw any medical decision that was motivated to kill a patient. This concession seems to have persuaded MPs to defeat an amendment from Catholic MP Iain Duncan Smith to stop the Bill being used for "bringing about the death" of patients unable to state their own wishes. There was uproar in the Commons when a letter supporting Lord Falconer's pledge from the Catholic Archbishop of Cardiff Rt Rev Peter Smith, and, later, Lord Falconer's own letter to the Archbishop, were circulated on Labour benches just minutes before the vote. In chaotic scenes, David Lammy, the minister defending the Bill, apparently only received the letters, both dated December 14, shortly before the end of a stormy debate. Mr Lammy ignored repeated pleas from MPs and the Deputy Speaker to clarify the Government's intentions, but just before the vote did declare that, in the Lords, the Bill would be changed. He said: "We have come to a form of wording where we will be able to bring an amendment that will say that where a determination relates to life-sustaining treatment, the decision-maker must not be motivated by the desire to bring about the person's death regardless of what would be in the person's best interest. I am convinced that this fully meets the concerns." Mr Lammy read from Lord Falconer's letter which said: "Neither of us want the Mental Capacity Bill to authorise any decision where the motive is to kill as opposed to relieving or ending suffering or ending treatment where the patient is an irreversible coma. "Any decisions must be in the patient's best interests. I believe this is clearly its effect but we will seek to make it explicit in the Bill." MPs were furious that the wording had not been put before them in an amendment they could vote on. The Archbishop wrote: "I greatly welcome this undertaking which, suitably worded on the face of the Bill, will remove the substantial objection which I and many others have had." In another last-minute concession, Mr Lammy suggested that the Government would tighten up 'living wills' so they had to be witnessed and written rather than verbal. Just 34 Labour MPs rebelled by voting for Mr Duncan Smith's amendment. About 100 more abstained. The Bill aims to set out a legal framework for so-called 'living wills' - instructions to doctors to withdraw treatment should patients become incapable of communicating their wishes. It will also enable third party advocates to tell doctors when to stop treatment of incapacitated patients. Both measures are opposed by pro-life campaigners who fear they will allow euthanasia by the back door and want greater safeguards for patients to change their minds. Iain Duncan Smith said the Government's use of the Archbishop's letter was "a wonderful trick" against its own side. He added: "I am a bit angry frankly with him because he is not right to intervene in the debate." Archbishop Smith said he wanted to see the details of any changes, telling the BBC: "In principle, I think they have conceded the point." The Society for the Protection of Unborn Children (SPUC) expressed deep disquiet that "the Government has refused to reverse the euthanasia nature of the Mental Capacity Bill and tonight whipped its MPs to force the Bill through a sceptical House of Commons." Paul Tully, SPUC general secretary, said: "The vote of 118 against the Bill at Third Reading reflected the reluctance of MPs to accept the Government's assurances about an alleged understanding with Archbishop Peter Smith that the Government would amend the Bill in the House of Lords to exclude euthanasia." He said: "The Lord Chancellor's letter to Archbishop Smith gives no indication of the text of any proposed amendments. It's all smoke and mirrors. The Lord Chancellor's ambiguous proposal crucially refers to excluding decisions only "where the motive is to kill" rather than intention to kill. What matters in the eyes of the law is the intention to kill - motive is simply what moved the person to kill, which might be a misguided notion of compassion. The Government rejected Report Stage amendments, backed by 200 MPs, which, while imperfect, represented concerns that the Bill would allow and even compel the denial of ordinary treatment, as well as basic care such as tube-feeding, from patients who can't communicate. Mr Tully concluded: "In the light of today's farcical proceedings in the Commons, we urge the House of Lords to give the Bill and any new amendments by the Government strict scrutiny, with a view to rejecting the Bill unless the euthanasia nature of the Bill is reversed."
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