Examination of Witnesses (Questions 2060
THURSDAY 20 JANUARY 2005
Q2060 Lord Joffe: Lord Walton, first
of all I would like to thank you very much for you opening comments
on the humanitarian principles behind this Bill. It is much appreciated.
If I could start off by clearing up the position in the Northern
Territories. In fact in the Northern Territories of Australia
there were only somewhere between four or it might have been six
cases before the legislation was over-ruled by the Federal State
which actually had the jurisdiction, because the Northern Territories
was, as it were, a territory and not a state.
Lord Walton of Detchant: Thank you.
Q2061 Lord Joffe: So I do not think
many conclusions can be drawn from the experience in the Northern
Lord Walton of Detchant: No.
Q2062 Lord Joffe: I would like to
come back to this point which has been raised by Lady Jay and
Lord Patel about the change in public opinionan opinion
in parts of an opinion, I thinkwhich you have clearly recognised.
It is extraordinary if one looks at that change and starts to
list it. We have the Royal College of Physicians, the Royal College
of General Practitioners and the Academy all moving from outright
opposition to a position, as you point out in the case of the
physicians, of neutrality. Internationally, we have had evidence
from Oregon, Belgium, The Netherlands, all of whom have introduced
legislation since your committee reported
Lord Walton of Detchant: Yes.
Q2063 Lord Joffe: -- legalising assisted
dying. In addition, we have Switzerland, where in evidence we
have heard that assisted dying has been in place there for something
like 100 years without any known abuse or abuse or without vulnerable
people being put at risk, and then, of course, public opinion
has remained at 80 per cent or more in favour of patients just
having an option. I wonder whether, with all this mass of opinion,
even though you have clearly made your position clear, has it
given you cause for thought? Has it influenced your thinking in
Lord Walton of Detchant: That is a very valid
question and the answer is that of course it has given me pause
to thought. I have considered this extremely carefully. Having
looked at much of the evidence that has come from public surveys
and from professional sources, and, indeed, from Oregon and Holland
and Belgium and Switzerland, I have nevertheless, after agonising
over this issue, stayed with the view which I have expressed today
and which I expressed in our report of '94.
Q2064 Lord Joffe: Thank you. I think
it is clear from what you say that the borderline between supporting
assisted dying and not supporting assisted dying is a very fine
Lord Walton of Detchant: It is a very fine one.
As I said in answer to the Lord Chairman's question, I am aware
of circumstanceseven, Lady Findlay, in hospiceswhere
on a couple of occasions I know full well that someone carefully
left some tablets next to the bed of a patient who was in terminal
illness, which they subsequently took and it terminated their
life. I have heard of one or two such cases. Very rare. Very occasionally.
I nevertheless do not condone that but I know that it has happened
on occasions. I accept that there is a distinction between helping
an individual to commit suicideI do not approve of itand
a doctor giving a lethal injection which is deliberate and intentional
killingwhich I still cannot condone under any circumstances.
Q2065 Earl of Arran: Lord Walton,
could I say straight away that I fully respect and, indeed, understand
your very principled objections to this Bill. You mentioned in
your opening remarks safeguards, and words to the effect that
you are pleased that they are as they are at the moment. From
a physician's point of view, if this Bill were to become law,
are there any additional safeguards you would like to see therein?
Lord Walton of Detchant: I have read it carefully
several times and if it were to become law I cannot readily see
any additional safeguards which I would wish to see introduced.
Q2066 Baroness Thomas of Walliswood:
Lord Walton, we have had in evidence quite a lot of discussion
about the length of time which is a suitable length of time at
which you can determine when a patient might die. In effect, the
Bill says that that length of time is six months.
Lord Walton of Detchant: Yes.
Q2067 Baroness Thomas of Walliswood:
That is what the effect of the Bill would be. I think other doctors
have said to us that they feel that at two to three months you
could be pretty certain what the prognosis of death is but in
a longer period it is much more uncertain. Do you have any comments,
as a physician, on that distinction?
Lord Walton of Detchant: In a lifetime of medical
practice I have been enormously surprised by a number of things
which have happened. I remember the wife of a friend, a physician,
who was suffering from what was regarded as terminal cancer, a
malignant melanoma with multiple metastases across the body, in
the liver and in the lungs and so on, to such an extentand
this was years agothat her husband who was abroad was brought
home from services in the armed forces to be with her when she
died. Within a period of two to three months the metastases disappeared
and she lived for another 30 years. That is an exceptional example.
Q2068 Baroness Thomas of Walliswood:
It is on the outside edge, as it were?
Lord Walton of Detchant: Well, I think it was
probably the body's immune response beginning to work very much
more effectively. These things are very unpredictable. There are
patients in whom one says on the basis of clinical experience
that the patient is likely to die within three or four weeks.
There are others where you say, "I think the patient has
six months, maybe nine months" etcetera, and time proves
you to be quite wrong, because they either live longer or die
earlier than you had anticipated on the basis of your experience.
So it is not an exact science. Clinical medicine never is and
never will be an exact science. For that reason, I think six months,
if the Bill did become law, would be a reasonable period of time.
I would not wish to shorten it.
Q2069 Chairman: Lord Walton, just
to follow a little bit further that line you have just been discussing,
my impression of the evidence is that those who deal primarily
with malignant conditions, cancerous conditions, on the whole
are more able to predict with some precision, particularly in
the closing months, perhaps two months, of life, when the end
will come than those dealing with a number of other illnesses
which ultimately are expected to end in death. It is said, I think,
that in that case it is more problematic. Is that in accordance
with your experience?
Lord Walton of Detchant: Absolutely. So far
as the cancer cases are concerned, I think the prediction is more
easy but by no means precise. In people, for example, with motor
neurone disease or other neurological conditions, with which I
am very familiar from my clinical practice, it is very difficult
indeed to predict what is going to happen. A patient with motor
neurone disease does not die as a consequence of the paralysis
of the muscles, which are progressively lost, unless of course
the respiratory muscles are badly affectedand, even with
some of them, when they are sentient and capable of intelligent
decisions they are helped by artificial respiration and a number
of other techniquesand of course it is very difficult to
predict how long people with motor neurone disease are going to
live. The same is true, of course, of people with many dementing
processes and other progressive neurological disorders, where
it is not the dementia which kills but the secondary consequences
of the dementia which usually will eventually kill the individual.
As I said at the outset, I recall very wellforgive me for
mentioning thisthe case of my own mother, who died eventually
at the age of 93. She had a series of six strokes and for the
last year of her life was unaware of her surroundings. On several
occasions, in discussion with the GP, the family said that if
she developed another attack of pneumonia we would not wish her
to be given antibiotics. In fact, she developed two more attacks
of pneumonia but recovered spontaneously each time. So these are
very difficult issues to consider.
Q2070 Lord McColl of Dulwich: You
mentioned the failure of the Abortion Act. It was very carefully
framed by very sincere people who thought they had put in place
very secure limits and yet the moment it was passed it did not
do what it was meant to do and abortion on demand became the norm.
Furthermore, the clause in the Bill to protect those who did not
want to take part, again that failed, although it was carefully
worded. I am sure you had many friends, as I did, who were obliged
to emigrate because they could not secure jobs in a surgical role.
My worry is that if that bill was carefully phrased but failed
to do what was intended, why would this Bill not also fail in
a similar way? That is one question. The second is this: We hear
that in Holland old people are genuinely worried because they
are not quite sure what the doctor is coming for: Is he coming
to help or to despatch them? We have also heard that the role
of the doctor might be compromised. What would you think to an
amendment which is being tabled which would preclude members of
the medical and nursing professions, and professions allied to
medicine, taking any part in this whatsoever? You would have to
have a different group of people or professions who would do this
job, so that there would be absolute clarity and no confusion
of the roles.
Lord Walton of Detchant: The first point I would
make is that you should forgive me, I think, for disagreeing with
the point you made at the outset, but I turn to the noble and
learned lord, the Chairman: I do not believe that the Abortion
Act has been significantly amended in relation to its provisions
but those provisions have been widely ignored, leading virtually
to abortion on demand. That is one of the major arguments which
concerns me about this Bill, that, if it were to be enacted, then
I believe, as I have said, that it would lead progressively to
the practice of voluntary euthanasia. That is my concern. As to
the second provision you have suggested, I feel uncomfortable.
I cannot comfortably feel that it would be possible to find a
group of individuals, who are sufficiently well trained and sufficiently
capable of taking into account all of the circumstances, who are
outside the medical and nursing professions, who would be willing
and able to do this. I think that is a dangerous possibility and
I would not wish to support it.
Q2071 Baroness Finlay of Llandaff:
I wonder if I could ask you one further question which has just
come to mind as a result of your response on your experience of
communication and communication training and the impact of what
the doctor says on what the patient perceives. If this Bill, in
any form, not necessarily its current form, were to proceed, whether
it should have a clause in it whereby it is an offence for a clinician
to instigate and offer euthanasiaas opposed to the question
being raised by the patient initiallybecause of the inference
to the patient that, if a doctor says, "Have you considered
euthanasia?" or "Have you considered assisted suicide?"
there is a subtext, a subliminal message, that what lies ahead
of them is so terrible that the doctor dare not spell it out and
that there is an inference that their life is either not worth
living now or may not be in the future.
Lord Walton of Detchant: I think that is a very
thoughtful suggestion and one which deserves very serious consideration.
Having said that, of course, I said at the outset that medical
schools have been teaching students communication skills now for
well over 25 years, but, even so, every doctor has had the experience,
after a lengthy consultation, a time which for a patient I understand
can be a very sensitive and difficult time, of asking the patient
at a later stage what was said on that first occasion, and the
inaccurate recollections are sometimes stunning and very disturbing.
In our medical school and in the vocational training programme
for general practitioners we had a regular procedure at Newcastle
of asking students to videotape a consultation with a patient
and then to have the videotape played back with their colleagues/peers
in the same class criticising their competency and then subsequently
asking some of those patients to come back and to explain what
they had been told in the consultation. And it is extremely difficult,
because sometimes they have misinterpreted what seemed to the
students and to some of the doctors to be very simple concepts.
So it is a complicated issue but, you are right, it needs to be
something which is vigorously pursued.
Chairman: Thank you very much indeed, Lord Walton.
I refrained from taking up with you the relative position of trust
of doctors and lawyers since I think it may not be directly relevant
to our discussions. Thank you very much indeed.