Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

Examination of Witnesses (Questions 540 - 552)



  Q540  Bishop of St Albans: But they would have to be killed by somebody else, so they are exercising their autonomy to impose an obligation on someone else without asking. They want to impose their will upon the medic to kill them.

  Dr Shakespeare: Actually I think the Bill says that all doctors would be able to conscientiously object.

  Q541  Bishop of St Albans: But there would be one person who ultimately would say, "Yes, I will".

  Dr Shakespeare: Yes, and there are doctors who make life and death decisions all the time so I do not see that this is any different.

  Q542  Bishop of St Albans: There is a difference, is there not?

  Dr Shakespeare: I am probably being obtuse, but I do not see it. If I can come back slightly, there is already evidence in many countries in the world of what would be called underground euthanasia, of illegal acts performed by doctors or by others on behalf of people who wish to die. That is unregulated, it is unknown and it may involve all sorts of abuse. I think there is a strong argument that careful regulation would reduce the abuse and, indeed, the defence of mercy killing because here is a very clear legislative proposal to limit and regulate it and so if it were outside those limits and regulations there would be no defence in law that I can see.

  Q543  Chairman: You could have mercy killing that was outside this Bill though, could you not?

  Dr Shakespeare: Yes, but if there is not an Act which legitimates it and says that these are the channels and these are the considerations and this is legitimate then presumably illegal mercy killing—it may happen—would be much less defensible in a court of law.

  Q544  Lord Carlile of Berriew: Just pressing that a little further, what is the difference between what is proposed in this Bill, Dr Shakespeare, and the following situation: a patient who, after good quality and intensive medical treatment, wishes to die from the extreme mental pain caused by an incurable mental illness? What is the difference?

  Dr Shakespeare: I do not know.

  Q545  Lord Carlile of Berriew: That is the slippery slope danger of your argument.

  Dr Shakespeare: I think that you have to draw a line somewhere and I think acute depression or schizophrenia is a hugely problematic thing and I know there are people who wish to die as a result of it and as impairments go it is a very severe impairment. However, my worries about capacity and about abuse and about people who are not competent lead me to feel that that it would be to go too far. Of course, if somebody is in that state then there is no obvious assumption why they could not commit suicide anyway. This is to cover people who are not capable of committing suicide themselves by virtue of their own capacity or their physical situation. It is true; your point is very germane to someone who had an acute psychiatric illness and an acute physiological restriction but I am afraid that any law has to be restricted and some people will have just claim but will be outside that law and I think that may be one of them.

  Q546  Lord Carlile of Berriew: I am talking about the real world of mental illness in which somebody may be detained under the Mental Health Act and may be physically disabled from obtaining the means with which to commit suicide. Why should they not be put in exactly the same position as someone under this Bill? If, as you seem to accept, there is really no difference between the two categories, is that not the starkest illustration of what has been called the slippery slope?

  Dr Shakespeare: I did not say that there was no difference. I said that it was a situation that I did not have a straightforward answer to. It seems to me that there is a question about their capacity and it seems that if this Bill had included such people I would certainly not have supported it; it would seem to me to be too open. It may be that your Lordships and others may wish to think carefully about that and extend this law. A slippery slope is one where we have no control over where we go next and where one thing leads to another without any consideration or way of stopping it. This is not a slippery slope because, as I understand it, it is a very tightly controlled Bill which will not give everybody what they are asking for. I am sure that many supporters of the Voluntary Euthanasia Society think this law is too restrictive and draconian and I am glad about that because if they were all happy I would be concerned.

  Q547  Lord Carlile of Berriew: I want to ask you an entirely different question. You raised the point about training and you expressed some confidence that good quality training could be made universal to clinicians. You cited as your examples the General Medical Council (which is not in fact a training organisation, it simply issues pamphlets for this purpose) and I think you said either the BMA or the BMJ. I do not know if you were here this morning when we heard the Government's leading expert on palliative care telling us that something called a Gold Standard had managed to reach out so far to 16 per cent of primary care general practitioners in this country, leaving something like 80 to 85 per cent to access over the years to come. What is your paradigm upon which you base your confidence that training could be given to clinicians in the matters raised by this Bill within a reasonable time so as to provide for robust training and medical supervision over those clinicians who wished to practice it and protected totally those clinicians who refused to practise it?

  Dr Shakespeare: I agree with you. I have tried to train GPs; I have offered to train GPs a lot and they are all too busy to take advantage of it. I think your point is germane but presumably the Bill can be amended to say that nobody can authorise a request to die if they have not been on an approved training course. That seems to me a practical problem and not a problem in principle. It may be that the law cannot come into practice for several years until that training has been achieved. So be it. I would be utterly supportive of resources and training going to GPs and to other clinicians. As I understand it, doctors are always going for periods of training. They are having to catch up with genetics at the moment which many of them do not know enough about. This will be another of the topics on which they will have to be trained but that does not stop us introducing new technologies or new possibilities in medicine because not everybody knows how to exercise them. It shows that we need to be careful about it, but it does not mean that we should not go down that road.

  Q548  Lord Joffe: Miss Davis, you talked about best interests. Who do you think should decide on your best interests?

  Ms Davis: I am happy with my best interests being regarded as traditionally regarded best interests. I am very concerned about, for instance, the definition of best interests which the Mental Capacity Bill proposes which would be the wishes and feelings of the person concerned. Nineteen years ago I wished to die and felt I would be better off dead but those wishes and feelings did not correspond with what was actually in my best interests.

  Q549  Lord Joffe: You think that the doctors or other people should decide on your best interests and other patients' best interests.

  Ms Davis: I think that a definition of best interests has already been set down, for instance in case law, and that is the definition that I think is correct, is safe and gives vulnerable people the most protection. Talking about people's wishes and feelings militates against people who are as desperate as I once was.

  Q550  Lord Joffe: Do you believe in the right of patients to refuse treatment even if the refusal leads to their death?

  Ms Davis: If the treatment is, as I said before, futile or if it disproportionately burdensome then yes. What I think a person does not have a right to do—because as I explained the right to life is inalienable—is to either request a treatment or refuse it with the intention that that refusal will bring about their death. It may be that their death will be a side effect of their decision to refuse the treatment but I do not think it should be the person's intention that refusal will cause death.

  Q551  Lord Joffe: The law is quite different in that. The law is that patients can refuse treatment and it is not a question of whether it is a wise decision, but it is their decision. So you disagree with the law as it is.

  Ms Davis: I do not think that advance decisions have legally binding status.

  Q552  Lord Joffe: I was talking about a request to withdraw treatment not advance decisions.

  Ms Davis: I understand that. I am thinking of the case of the man who was schizophrenic and he had a gangrenous leg and he refused treatment to have it amputated. Presumably that is the sort of case you had in mind. That case has sometimes been cited as evidence that people may refuse treatment for any reason whatsoever, but in that case it had not been established that he wanted to bring about his death; he simply did not want to have the operation and did not want to have his leg amputated. I think we have to be very careful about what the person's reason is. That has been cited as a reason why, for instance, advance decisions are legally binding; I do not accept that they are. I think in that case the person's reason for not wanting the surgery were not probably to bring about his death.

  Chairman: I am inclined to think that we have had a fairly long day and we should stop now. Thank you both very much indeed for your help. You will have a chance to correct the transcript of the evidence, not of course to alter what you said but just to make sure it is properly recorded.

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