Examination of Witnesses (Questions 1700
- 1710)
FRIDAY 17 DECEMBER 2004
PROFESSOR GERRIT
VAN DER
WAL, DR
BREGJE ONWUTEAKA-PHILIPSEN
and DR AGNES
VAN DER
HEIDE
Q1700 Lord Joffe: But you did say
that in your last study 100 per cent were incompetent?
Professor van der Wal: Yes.
Q1701 Baroness Finlay of Llandaff:
The next time you do the study, how will you supplement your questionnaire
to clarify some of the issues around exactly what was done, differentiating
between symptom control, escalating drug dosages, and a specific
intervention of euthanasia, as defined in the protocols that we
have been given—which are very specific about an overdose
of barbiturates, with or without curare to paralyse the patient?
Professor van der Wal: We finished a new research
proposal two days ago, but we do not know whether it will be granted.
We hope and think so. The people who have done most of the work
are here with me, so perhaps they could respond to this question.
Dr van der Heide: The denominator of the death
certificate study, the denominator for the euthanasia cases, has
to be clarified—which cases are not reported and which cases
are reported. One of the main insights our studies have given
us is that, on the one hand, you have very clear euthanasia cases
that fulfil all criteria and that could not be defined otherwise.
On the other hand, you have cases that could be interpreted as
being euthanasia or otherwise. It depends on who judges what happened,
who has an interest in it, and how large or how small this part
of this total number of euthanasia cases is a matter of personal
judgment, or whatever. What we now plan to do is to follow up
all cases of euthanasia we find, and to send physicians an extra
questionnaire. We could not do so in the previous study because
of the anonymity requirements, but we can probably be somewhat
more liberal in this study, and that is why we can send subsequent
questionnaires specifically to ask physicians, "Did you report
this case or did you not? Why did you do so? Why did you not do
so?". Then we will be more able to distinguish the total
denominator in the cases reported and those cases unreported,
and the reasons.
Q1702 Chairman: The numerator is
definite. The denominator in the previous studies is open to a
certain question, and you may be able, in the new study, to firm
up the denominator as well. If you did firm it up, would it probably
go down somewhat?
Professor van der Wal: Yes, probably. At least—
Q1703 Chairman: Not up?
Professor van der Wal: Not up.
Q1704 Chairman: It can hardly go
up. You raise a question in my mind. You are asking for funding
for a research project. Is it the State that funds these projects
or is there some other source of funding? Is it the State?
Professor van der Wal: Yes, the government.
Q1705 Lord Carlile of Berriew: Through
the university or direct to the Health Department?
Professor van der Wal: No, there is an in-between
organisation. In the previous studies, the funding was directly
from the government to the university. Now they have an open procedure.
So we have to write and to compete with others. There is a kind
of research council, as you have in the UK, which divides the
money and which will judge and review the proposal.
Q1706 Chairman: But ultimately, if
the research project is funded, you will get the funding in your
department through the university for that project?
Professor van der Wal: Yes.
Q1707 Chairman: And you will be able
exercise the necessary control to get the figures that they are
looking for?
Professor van der Wal: Yes.
Q1708 Baroness Finlay of Llandaff:
I have so many questions, but may I ask one more?
Professor van der Wal: You know that you have
my e-mail address!
Q1709 Baroness Finlay of Llandaff:
Is anyone doing an observational qualitative study, prospectively,
watching clinicians and their decision-making processes, amongst
those who never practice euthanasia and those who practise euthanasia?
Professor van der Wal: No, but there have been
two qualitative studies. One ended in a thesis which is translated
into English. It has been done by Anne-Mei The. She is from our
department. Maybe you know that book?
Q1710 Baroness Finlay of Llandaff:
No, I would like to see it.
Professor van der Wal: I am sorry. I was mistaken:
it is not translated. That is the other book. There is another
study, done by an American colleague who is finishing her thesis
at the moment, but we have not seen her results yet.
Chairman: Thank you very much indeed. It is
very kind of you and, as I have said, you will get a chance to
review the transcript in due course.
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