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

Examination of Witnesses (Questions 2060 - 2071)



  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 Territories.

  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 opinion—an opinion in parts of an opinion, I think—which 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 any way?

  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 one.

  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 circumstances—even, Lady Findlay, in hospices—where 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 suicide—I do not approve of it—and a doctor giving a lethal injection which is deliberate and intentional killing—which 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 extent—and this was years ago—that 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 affected—and, 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 techniques—and 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 well—forgive me for mentioning this—the 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 euthanasia—as opposed to the question being raised by the patient initially—because 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.

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