Examination of Witnesses (Questions 260
THURSDAY 14 OCTOBER 2004
and DR IVAN
Q260 Baroness Finlay of Llandaff:
From a specialist service or from the service that Ivan Cox outlined,
which is generalist education?
Professor Tallis: Within our own service we
have some very good palliative care nurses, who are involved very
early on in our wards and connect with the wider palliative care
Q261 Baroness Finlay of Llandaff:
Do you have a specialist consultant service?
Professor Tallis: We have access to it through
the palliative care nurses and we are able to access the full
palliative care service, so we are very fortunate in that sense.
Q262 Baroness Finlay of Llandaff:
Professor Saunders, do you have a comment?
Professor Saunders: No, only to say that we
have discussed this issue within the College. Yes, we have no
view on it and that reflects the divisions within the College.
Again, I do not particularly want to go off message and give you
a personal opinion but I do not see that there is any logical
objection to the idea of a separate service. I do not think this
has been adequately evaluated anywhere. I just make that as a
statement of fact. There are those who feel that it is the physician's
job to accompany their patient on the journey as far as they can,
and that may mean to the end literally. There are others who feel
that this in some way contaminates medicine. I do not think we
have any empirical data from other jurisdictions that would inform
whether such authorised assistance in suicide or active killing
should be done by another professionas I said in my submission,
obviously not a funeral director, but perhaps pharmacists and
nurses and so on. In all seriousness, there may be a role for
other professional groups.
Dr Cox: If I could come in and also make a comment,
I do not think we have any definite evidence that there are doctors
who would want to be the doctor that carries out the assisted
dying. In some respects we have got ourselves mixed up with two
different entities here. One is discussion of what used to be
called assisted suicide. It seemed to mean that the doctor left
a prescription for some tablets for the patient to take as and
when they wanted to. We now are talking about the doctor deliberately
killing the patient in the same way, almost with a contagious
element to it, as someone carrying out an execution. We do need
to address the difference between those two because it does have
emotive issues although they are one and the same thing. As I
say, we have not got any evidence as to how many doctors in this
country would want to participate in this as far as I am aware,
and no doubt the committee will achieve this at some stage or
other. There was a paper in the BMJ not long ago which had asked
the question of about 400 or 500 New Zealand GPs whether they
actively participated in assisted suicide. Remember, of course,
that in New Zealand assisted suicide is not legally available.
Roughly 50 per cent of the GPs who were asked said that in the
terms of their definition they had in fact carried out assisted
suicide. When you talk to GPs in this country they will say that
they have assisted patients in dying but this may be what some
of us would call a double effect; in other words just raising
the dose of morphine in already dying patients simply to make
quite sure that they do not suffer and it is almost a coincidence
that they die as a result of an excessive dose of morphine. Again,
it all relates to definitions. I hope that Baroness Finlay understands
where we as GPs come from.
Chairman: Thank you very much indeed.
We have been much helped by your submissions both in writing and