59.Memorandum from Professor David d'Avray
My mother was in a coma for six years. After
her death I corresponded and talked with Mr M I Hinchliffe of
the Official Solicitors office about such situations. I feel I
know something about them and hope you will take it into account.
My mother was not in a vegetative state but
she was paralysed and it was unclear how much she understood.
Her first consultant (Dr Simpson of Chichester Hospital) did not
think it good that she should survive, and refused to treat an
infection. (She survived anyway.) However he agreed with the family
that nourishment should not be withdrawn. He said that he thought
it would cause distress. You need to think through the implications.
Mr Hinchliffe's view was that patients in a
permanent vegetative state suffered not pain, but he added: "I
acknowledge that the same may not be the case in relation to patients
whose condition falls even slightly short of this." (Letter
dated 18 December, 1996). He is a man of integrity whose opinion
should carry much weight with you.
Note that neither Dr Simpson nor Mr Hinchliffe
shared my own feeling that it is wrong to intend a patient's death
even through inaction. They nevertheless did not deceive themselves
about the possibility of distress caused by withdrawing nourishment
from patients not in pvs.
When beds are short in hospitals or when places
in a kindly nursing home have financial implications for families
there is a danger of doctors and family members assuming too easily
that a patient is in pvs: It would be naive to assume that such
self-deception is impossible. Even without it mistakes could be
Mr Hinchliffe (tremendously honest and fair
despite our disagreements) told me of a case in his personal experience
that you should find worrying. Before the coma the person had
indicated that they did not wish to be kept alive in circumstances
such as actually transpired: a light coma allowing for minimal
communication through signals. Mr Hinchliffe visited this patient
in his professional capacity and was able to ask what he or she
wanted (I forget if it was a man or a woman but he would certainly
remember). He told me that he was rather shaken when the patient
clearly indicated a wish to be kept alive. This makes me think
that living wills are dangerous.
I suppose that patients in pvs do not suffer
when kept alive: what of the others? Having spent so much time
with my mother over those six years I can say that quality of
life is possible. Her family were able to show her constant affection,
she watched tv, the staff of her nursing home treated her as a
person. She was aware, followed one with her eyes etc, and my
father told me that a day or two before her death she spoke. I
suppose her quality of life was much better than that of a severe
depressive. There is a lot that can be done with perfumes, ointments,
videos etc to make it bearable. You have to have had such a situation
in the family to realise how different the whole thing is from
situations you see on tv.
Later one of my acquaintances told me that he
had himself been in a coma for a short period after an operation
that went wrong. He understood everything that was said around
him but had no sense of time. I could put you in touch with him
if you wish (he lives in Germany).
As you can see from the above, the proposed
Bill fills me with disquiet.