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


Examination of Witnesses (Questions 2220 - 2239)

WEDNESDAY 2 FEBRUARY 2005

DR CHRISTOPH REHMANN-SUTTER and DR MARGRIT LEUTHOLD

  Q2220  Baroness Finlay of Llandaff: The question in that study was about the intention with which an action was taken. It did not look at what was actually done.

Dr Leuthold: No, no. They looked at what was actually done.

  Q2221  Baroness Finlay of Llandaff: But did they actually look at the final dose of drug given? I thought they asked the physician what the intention was behind the last dose of drug given, but in some of those you cannot be sure that it was the drug that killed the patient or whether the patient was dying of their disease anyway and they had a dose of drug but it was not the drug that killed them, because to kill people you are talking about nine grams or so of barbiturate and in those sometimes it was milligrams of an opioid, if I remember. I may have remembered it wrongly.

Dr Leuthold: You are correct. I would not rely too much on these figures but nevertheless they give us some evidence about the real situation. Even these numbers might be different or need interpretation.

  Q2222  Baroness Finlay of Llandaff: Or they give you evidence of ignorance amongst the physicians about the pharmacology of the drugs that they have prescribed.

Dr Leuthold: But the study set up would not have been very good. It is self-declaration, of course. It is a way of interpreting a situation at the end of life to mark here or there.

Chairman: Which study is that? Is that one of the van der Wal studies?

  Q2223  Baroness Finlay of Llandaff: No, it is not. It was another one.

Dr Rehmann-Sutter: Van der Heide in The Lancet.

Baroness Finlay of Llandaff: Yes, it was in The Lancet, one of six nations. We have got that.

  Q2224  Chairman: That is the same one as we had in Holland, is it?

Dr Leuthold: Holland, Belgium, Switzerland, Denmark, Sweden, Spain.

  Q2225  Chairman: It is just that I want to be sure we have the right one if there is any doubt about what the specific facts were.

Dr Rehmann-Sutter: It was in The Lancet, Agnes van der Heide.

  Q2226  Baroness Finlay of Llandaff: Just now when you were talking I think you said 700 physician-assisted suicides.

Dr Leuthold: No 700 cases of, let us say, physician-assisted death. I refer to this number—one per cent out of the 70,000 death cases in Switzerland.

  Q2227  Baroness Finlay of Llandaff: These figures, which I have only just been given, and perhaps I am misunderstanding them, suggest that there are 30,000 deaths. This was in the year 2000 with a total of 900 suicides, and 713 were under the age of 65.

Dr Leuthold: That is only male.

Baroness Finlay of Llandaff: Oh, sorry, and then I have got to add in females.

Chairman: Some females died as well apparently.

Baroness Finlay of Llandaff: Yes, but with fewer suicides.

Baroness Hayman: They do not come on the statistics, Chair.

Baroness Jay of Paddington: If you do not work you do not die!

  Q2228  Baroness Finlay of Llandaff: These were ordinary suicides?

Dr Leuthold: Yes.

  Q2229  Baroness Finlay of Llandaff: But in the others they were end-of-life decisions. The figure you are talking about is for end-of-life decisions, is it not?

Dr Leuthold: Yes.

Baroness Jay of Paddington: We are all talking about papers which most of us have not seen.

Chairman: Exactly. Are we going to see the paper you are talking about, Lady Finlay?

Baroness Finlay of Llandaff: You are welcome to have it. It is the Federal Statistics Office's publication in 2004, and the figures are from the year 2000.

  Q2230  Baroness Jay of Paddington: Could I go back to the general point, and I know this is a very delicate area and I am not asking you to make any specific comment, but in the area that you have described where the theory or the practice may be different from the guidelines or the law, have there been any cases that you know of, in which assisted suicide has been conducted in the sorts of circumstances that Lady Hayman has been describing of someone in the very advanced stage of ALS and not quite able to push the pump themselves, where anyone has been prosecuted for appearing to help them end their life?

Dr Leuthold: To my knowledge such a case never came to the court. I cannot think of any. The only cases we remember are those where there were selfish motives.

  Q2231  Baroness Jay of Paddington: So they were different "wrong motives"?

Dr Leuthold: Yes.

  Q2232  Baroness Hayman: What about the disciplinary consequences for physicians who act? These are guidelines. I wanted to ask what force the guidelines had. You said earlier that if a physician assisted suicide under the terms of Article 115, even if it was not an end-of-life case, would not be a criminal offence.

Dr Leuthold: No.

  Q2233  Baroness Hayman: It would not be a disciplinary offence?

Dr Leuthold: These guidelines are a kind of code of conduct for physicians.

  Q2234  Baroness Hayman: What happens when someone breaks the code of conduct?

Dr Leuthold: Most of our guidelines are part of the code of practice of the Association of Medical Doctors in Switzerland, so if you do something against this code of practice then in the worst case you can be excluded from this Association. It is more a moral code of conduct in that the medical doctors know what is the ethically approved standard.

  Q2235  Baroness Hayman: We have the same system in the United Kingdom and the General Medical Council is almost in continuous session with complaints against doctors for more serious or less serious breaches of the codes. It may be relationships with patients or all sorts of things. You are saying that there have been no disciplinary hearings around assisted suicide because that presumably would mean that there have not been complaints by families about the behaviour of physicians.

Dr Rehmann-Sutter: I do not know.

  Q2236  Chairman: Where would these complaints go to in your system? Who is in charge of the regulation of doctors? If a doctor breaches a part of the code is it the Association that deals with it?

Dr Leuthold: It is the Federal Association of Medical Doctors.

  Q2237  Chairman: That is not the same as yours?

Dr Leuthold: No. We are kind of the ethical consciousness. The Association is one of our founders. We have a very strong link and the President is always a member of our board.

  Q2238  Chairman: I just wanted to be absolutely right, but I think I am right in saying that these guidelines are for the care of the terminally ill and that is why it is assumed that you are terminally ill if you are seeking assisted suicide in the subject that that guideline deals with, but it would not, of course, be a breach of the guideline if you dealt with an assisted suicide in a situation with which the guideline does not deal, namely, where you have not reached the stage of terminal illness but there is some other condition that has produced a desire to die and the physician has assisted it. Is that right?

Dr Leuthold: That is right.

  Q2239  Baroness Hayman: I would be very interested, Lord Chairman, if it was possible to make some inquiries of the disciplinary body, to know if there was any data about complaints against physicians in relation to assisted suicide.

Dr Leuthold: I am sure that there are no such cases but I do not know really.

Earl of Arran: One is left believing, therefore, that the interpretation of the law is very liberal.

Chairman: Why do you say that? I have no information so far to suggest that the law has ever actually been broken.

Baroness Jay of Paddington: Or has never been invoked.


 
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