Examination of Witnesses (Questions 1800
- 1809)
THURSDAY 13 JANUARY 2005
Rev Professor Robin Gill, Rt Rev Christopher Budd,
Dayan (Judge) Chanoch Ehrentreu and Dr Khalid Hameed
Q1800 Chairman: The theory is that
consent would be required and therefore this discussion you are
speaking of would not take place against a background of consent,
but in a preliminary situation, before the question of consent
is resolved.
Rt Rev Christopher Budd: It could be after as
well; someone may have given consent and suddenly thought "Hang
on. I'm not sure I really want this. Can I see the padre?".
That is very crucial.
Q1801 Chairman: So far as the Bill
is concerned, if the Bill became law and the person was able,
before the doctor actually did anything, to say they had changed
their mind, then the doctor would be precluded from proceedings.
Rt Rev Christopher Budd: Sure. I think you would
in fact have a hard job to put regulations to protect that. That
is my gut feel.
Rev Professor Gill: May I add a slight rider
to that? It would seem to me that you would probably have to go
down the same path as abortion in the sense that doctors who conscientiously
object to this must then refer their patients to other people.
One of the difficulties for Catholic doctors is that inevitably
makes them complicit in the act; inevitably.
Q1802 Chairman: That is the difficulty
about conscientious objection, whether it is a Catholic one or
otherwise.
Rev Professor Gill: Absolutely.
Q1803 Chairman: There may even be
Anglicans who have conscientious objections.
Rev Professor Gill: I am sure there are.
Q1804 Chairman: You could have a
situation in which conscientious objection, if it means that you
must refer to somebody else, would in a sense be overruled.
Rev Professor Gill: Yes; absolutely. You cannot
avoid that.
Q1805 Baroness Hayman: You raised
a question before this very interesting debate which I just wanted
to follow up, particularly with Professor Gill. You were talking
about whether there was a distinction between the Oregon model
of the giving of the prescription which then was totally in the
patient's hands and where we had evidence that many people take
and do not use, but derive some comfort and reassurance from and
the physician-administered assistance to dying. You answered that
in ethical terms and moral terms and that you did not see a distinction.
Earlier—and I wrote it down because it was a phrase which
was repeated a couple of times—you talked about the danger
in a more practical sense of intentional killings in a clinical
setting. I just want to explore that. What we saw in Oregon were
not intentional killings in a clinical setting at all. Most of
what happened was in patients' own homes. It was patient administered;
it did not have physical doctor involvement there. I just wanted
to explore whether you would still categorise the Oregon law,
which is not what is in Lord Joffe's Bill at the moment, as intentional
killings in a clinical setting that were particularly dangerous
for the majority of society rather than for the individual?
Rev Professor Gill: You are right: there is
a prudential side to this. I was just expressing the straightforward
ethical argument and, as you know, in philosophy there is no difference
between acts and omissions, for example, if you intend to do both.
So omitting to save somepeople from drowning, when you know you
could help them and stop them drowning, is really no different
from pushing them into the pond in the first place.
Q1806 Baroness Hayman: But in legal
terms?
Rev Professor Gill: You did ask me in ethical
terms. In prudential terms, in terms of safeguards and so forth,
there is some advantage in that in the sense the person clearly
has to be confident that the patient is capable of taking it for
themselves and it does not involve some of the knock-on effects.
You still have problems though; it does not eliminate the problems.
You still have the problem of whether or not you get slippage
in terms of people who are not actually terminally ill and what
you mean by terminally ill and how terminally ill they really
are and whether they are just chronically depressed; all those
things still have to be resolved. In terms of the actual Act "Yes,
this is clearly somebody who is competent, somebody who can do
it for themselves" yes, all those are prudentially there.
Q1807 Baroness Hayman: I do understand
some of the complexities and I am not suggesting it is simple.
The reason I explored it with you was because you were very vocal
about the BMA discussions and how that intentional killing in
a clinical setting perhaps in some ways tipped the balance there.
In our discussions with clinicians in Oregon, it was interesting
how firmly they felt that there was an important distinction between
administration and the provision of means by which patients could
help themselves and for the medical community of Oregon that seemed
to be a pivotal issue. I just wondered in BMA ethical discussions—
Rev Professor Gill: You are probably right.
I find it much easier to kill mice with mousetraps than bang them
on the head.
Q1808 Baroness Hayman: Do not let
us get into animals.
Rev Professor Gill: If you have mice in your
house, it is difficult. You can of course use humane traps and
give them to somebody else; I understand all that. Of course there
are these things and all of us have that and I am sure that is
right. I am sure doctors would be more comfortable with that.
Rt Rev Christopher Budd: A gloss on what Robin
has said. I would give "clinical setting" a wide context:
any intervention of a doctor and therefore the patient/doctor
relationship is involved even if outside a strict clinical setting.
That would be my gloss.
Q1809 Chairman: Would it make any
difference if it were somebody else who made up the prescription?
Rt Rev Christopher Budd: A line of formal co-operation;
they are all involved. The unifying intent is to kill this person.
Rev Professor Gill: It was the American, Dr
Kevorkian, who thought we ought to have thanatologists.
Chairman: Thank you very much indeed.
You will get a chance to review what the shorthand writers have
taken down in order to ensure that it is what you said that we
record. Thank you very much indeed.
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