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

Examination of Witnesses (Questions 1800 - 1809)


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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