Examination of Witnesses (Questions 1640
- 1659)
FRIDAY 17 DECEMBER 2004
PROFESSOR GERRIT
VAN DER
WAL, DR
BREGJE ONWUTEAKA-PHILIPSEN
and DR AGNES
VAN DER
HEIDE
Q1640 Baroness Finlay of Llandaff:
So you used high probability and low probability?
Dr van der Heide: Yes.
Q1641 Baroness Finlay of Llandaff:
Do you know how accurate death certificate data is in Holland?
I ask that because we know that in the UK it is notoriously inaccurate.
Dr van der Heide: To some extent that is also
a problem in The Netherlands, but we use relatively little information
from the death certificate itself. We use only the cause of death
and some data about the patient's age, sex, et cetera. All other
information—about which decisions were made, how these decisions
were made, which drugs were provided, et cetera—is based
upon our own questionnaire and not on the information from death
certificates. It is a problem, but it does not really affect our
results.
Q1642 Lord Carlile of Berriew: Once
you have received the questionnaire from the doctor, do you then
compare the questionnaire once again with the death certificate,
or do you not look further at the death certificate?
Dr van der Heide: No, we only use, as I have
said, the cause of death, age, sex and—
Professor van der Wal: Place of death.
Q1643 Lord Carlile of Berriew: Then
you do not return to the death certificate at all, but rely totally
on the questionnaire?
Dr van der Heide: Yes.
Q1644 Baroness Finlay of Llandaff:
On the questionnaire you did not ask about the details of the
cause of death?
Dr van der Heide: No.
Q1645 Baroness Finlay of Llandaff:
It might be interesting in future to ask that, and then go back
to the death certificate and try to match up to see?
Dr Onwuteaka-Philipsen: In the next round it
might be possible.
Dr van der Heide: You must understand that the
death certificate study is limited, first of all by very strict
requirements for anonymity and, secondly, because the questionnaire
has to be limited in size, we can only ask a few questions. We
have many thousands of doctors and we want the response rate to
be as high as possible. That is why in the study we ask only the
key questions and are not able to go into all kinds of details.
Q1646 Baroness Finlay of Llandaff:
If we were to do in the UK the type of study that you have done,
would you have any advice for us as to how we could learn from
your important experience and perhaps do it better, matched for
the UK?
Professor van der Wal: I think so, yes.
Q1647 Baroness Finlay of Llandaff:
Please!
Professor van der Wal: We could talk for more
than one day about that. As you probably know, we used a different
methodology in our repeated studies, but the core methodology
is the death certificate study—to get good estimates of
end-of-life decisions. So, about the cause of death and other
circumstances, we performed physician interviews. These were samples
from physicians and not from deaths. We have already used this
methodology in five other European countries, so it must also
be possible in the UK
Q1648 Chairman: The physician interviews
were on a sample of the sample, were they? Did you interview physicians
in each of the cases in which you sent out questionnaires?
Dr van der Heide: No, those were two separate
studies. The death certificate study was a written survey, completely
anonymous, so that we could not follow up any physician, and another
study was—
Q1649 Chairman: So this 3,800 figure
came from that study?
Dr van der Heide: From the death certificate
study.
Q1650 Chairman: That came from the
death certificates, which are themselves in the statistical archives
of the state?
Dr van der Heide: Yes.
Professor van der Wal: But we also tried to
make estimates from the physician interview study in 1990, 1995
and 2001, and on each of those three occasions the estimates were
rather similar.
Q1651 Lord Carlile of Berriew: How
many questionnaires did you send? I think that you did between
400 and 460 interviews.
Professor van der Wal: Yes, face-to-face.
Q1652 Lord Carlile of Berriew: How
many questionnaires did you send out?
Dr Onwuteaka-Philipsen: In the death certificate
study?
Q1653 Lord Carlile of Berriew: Yes.
Professor van der Wal: Over 6,000.
Q1654 Chairman: For each?
Dr van der Heide: For each study, in all three
years.
Q1655 Chairman: And you did them
over a four-month period?
Dr van der Heide: Correct.
Q1656 Chairman: And the 3,800 was
done by multiplying by three?
Dr van der Heide: Yes, more or less.
Q1657 Chairman: That is an approximation.
There were the other questions. Professor, I think that you were
going to deal with one of them?
Professor van der Wal: Yes, I will try. That
was about the trust?
Q1658 Chairman: Yes.
Professor van der Wal: In our general public
study we asked specifically about this. In terms of our research
results, we do not think that there is a distrust, or less trust
among patients, nor among the general public, nor among individual
patients, in the Dutch physicians—nor distrust because of
the recent law, jurisprudence, or publications about practice.
On the contrary: you may have read in the Dutch papers recently
that there is a new debate about how to respond to old people
who request help to die when they are tired or weary of life.
In short, Dutch doctors do not like to get involved in those questions,
but there are a lot of people, especially older people, who support
this idea. I think that you could see this as reflecting a lot
of trust in Dutch physicians.
Q1659 Lord Taverne: Are there any
opinion polls?
Professor van der Wal: Yes.
Dr Onwuteaka-Philipsen: This is about the law;
it is not really about trust. Regarding the law, 92 per cent think
that it is good that a doctor will no longer be prosecuted for
euthanasia, if all the requirements are met; 91 per cent think
that there should be control on euthanasia. They do feel it important
that there is some form of control.
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