Joint Committee on the Draft Mental Incapacity Bill Written Evidence

54.Memorandum from Dr John Scotson (MIB 62)


  1.  I write as a retired medical practitioner who has cared for many dying patients. I take a special interest in this Draft Mental Incapacity Bill in so far as it could affect the care given to the dying and could be used to bring human lives to a premature end, empowering or enforcing medical attendants to abstain from giving that care to which all dying people are entitled. Moreover the Bill is dangerous in the extreme, m so far as the law affects attitudes, because if it becomes law respect for human life will further diminish, doctors attending patients who have made living wills will on occasions be hampered for doing what they know to be in the best interests of the patient.


  2.  It is important to bear in mind some devastating events which have occurred in the last century and the beginning of this century in the hope that they that they may not continue or be repeated.

  3.  During the past century and the beginning of this century lives both of the bom and unbom have been needlessly taken; killing has been legalised, witness the epidemic of abortions—about six million abortions performed since the abortion act in 1968. Doctors m the Netherlands, where euthanasia has become commonplace, have co-operated in the suicides of people with early-stage HIV, anorexia and depression. A number of doctors in the Netherlands admit to killing patients without obtaining prior consent. In the course of the euthanasia "action" programme carried out in Nazi Germany more than 80,000 mental patients had been gassed between September 1939 and August 194[1]1. It is sometimes erroneously believed that the atrocities which have happened in the past cannot be repeated in this country: however all human societies and all individuals are capable of both great humanitarian acts and also evil acts mainly by doing harm to others. We must safeguard our laws and our society with the utmost vigilance not allowing any practices to be legalised which will result in harm or death to others.


  4.  In respect of this Draft Bill certain aspects merit special consideration. First: it is of paramount importance to understand that wishes expressed by the healthy in respect of action or inaction to be adopted when they are in a terminal, critical or unhealthy condition are not usually their wishes when that condition has been reached as any member of the medical or nursing professions will attest. Attitudes change when a patient changes from a healthy individual to one who is ill. As has been stated "Euthanasia is a minority interest amongst the terminally ill." To illustrate the point one recalls the conversation in the old persons home when it is agreed among the residents that none of them, bar one, would wish to live to the age of 100. The one who dissents is age 99.


  5.  Hypothetical situations described to those invited to make living wills and advance decisions, which will not have to be registered and can be made orally, are fraught with dangers both for the future patients and their doctors. For instance conditions such as Persistent Vegetative State may be described to a person following which the person may be asked what would their wishes be if they became locked into this state. However the term vegetative applied to human life is inappropriate, implying as it does that the person has ceased to be a human being. Dr Keith Andrews writing in the Journal of the Royal Society of Medicine said "in our own unit, 40 per cent of Those with a diagnosis of vegetative state were found to be have been misdiagnosed, some for several years".[2]Some patients in the supposed vegetative state have recovered—for example: a person named Patsy White Bull, an American Indian mother of four recovered after 16 years in coma in December 2000[3]Medical conditions thought to be irreversible are on occasions proved to be otherwise.


  6.  While killing must always be abhorrent to a civilised society needless or burdensome treatment need not be given and should not be given to those who are dying. Nonetheless ordinary care and attention including the giving of food and fluid, on which all human life depends, must always be given. The exceptions to the rule of giving fluid is when death is imminent and the benefit of giving fluid would have no value. Death by dehydration is painful in the extreme. To see a patient who has a completely dry infected mouth and inelastic skin is to understand the intense suffering to which they are subjected.

  7.  It must be understood that the phrase "artificial nutrition and hydration" is a nonsense in so far as the administration of food and fluid, however administered, can never be deemed artificial or constitute medical treatment. In the same way as oxygen cannot be described as artificial if administered by a face mask. Where a patient is denied administration of food and fluid and dies of dehydration or malnutrition that patient will have been deliberately killed and will not die because of the underlying disease but of dehydration and malnutrition. The ethical principle is that nothing should be done with the deliberate intention of killing the patient.


  8.  The commandment "you shall not kill" and the Hippocratic teaching—"I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it. I will not give a fatal draught to anyone if I am asked; nor will I suggest any such thing" could be undermined if this Bill becomes law. The attending doctor could be prevented from using his/her powers to help the sick, mentally affected and the dying through a wish previously expressed either orally or in writing conceming a future hypothetical situation. This "wish" could be expressed by a third party on behalf of the patient—a situation which is open to abuse. The Bill, if adopted, would lead to the widespread practice of eugenics and euthanasia.

1   Second World War Martin Gilbert Chap 17 p 228. Back

2   Vegetative State-background and ethics J R Soc Med 1997 90 593-596. Back

3   Sunday Telegraph 9 January 2000 p 24. Back

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