Supplementary evidence from the Chair
of the Ethics Committee of the APM
Thank you for listening to the Association for
Palliative Medicine of Great Britain & Ireland's evidence
on 21 October 2004. As requested by your chairman, Lord Mackay
of Clashfern, I have sent the reference Glare P, Christakis N
Predicting survival in patients with advanced disease.
Oxford Textbook of Palliative Medicine Edited by Doyle D, Hanks
G W, Cherry N and Calman K, Oxford University Press 2004 pp 29-40
to the Clerk to the Select Committee.
I would like to take this opportunity to clarify
some points in the APM's evidence:
1. "Doctors (and other healthcare professionals)
are not very accurate when making temporal estimates in individual
patients, although this may be improving" (Summary in article
2. The House of Commons Health Committee
(July 2004) received evidence on the current patchy provision
of palliative care and recommended an expansion of consultant
3. Palliative care professionals cannot
function as gatekeepers to euthanasia or physician assisted suicide.
To contemplate this is to misunderstand the close trusting relationship
which must exist with a patient if intimate issues such as concerns
about death and dying are to be discussed.
4. The assessment process as outlined in
the Bill is fraught with practical difficulties:
What is to be done if the doctors
Patients may be informed that palliative
care exists but this is quite different from experiencing this
care. Many patients are initially reluctant to be referred to
specialist palliative care but once they receive this care they
wish that they had come earlier.
In view of the acknowledged difficulties
in diagnosing depression, particularly in the elderly, a psychiatric
assessment should be mandatory not optional.
5. There is nothing in the Bill about the
practicalities of administration of euthanasia and physician assisted
suicide. May I draw your attention to Groenewood J H et al,
Clinical problems with the performance of euthanasia and physician
assisted suicide in the Netherlands. New England Journal of
Medicine 2000: 342: 551-6. This paper highlights the fact that
there may be suffering associated with euthanasia and physician-assisted
6. The retrospective monitoring is an inadequate
safeguard for doctors. Why are requests not assessed prospectively?
7. Implementation of this legislation may
undermine the high standards of the care of the dying which have
been achieved in this country. Improvements in care can only result
from rigorous research and provision of appropriate levels of
resources. This issue is far too important to be influenced by
existing poor market research based on opinion polls and postal
questionnaires. Proper studies with rigorous, unbiased methodologies
need to be conducted and published in peer reviewed journals.
8. I am aware that the Select Committee
are planning visits to the Netherlands and to Oregon. The APM
would be delighted to arrange a visit to a specialist palliative
care unit in this country, so that Committee members can see at
first hand the reality of current practice. Please let me know
if the Committee wishes to take up this invitation.
Dr David Jeffrey MA, FRCP(Edin),
Chair of Ethics Committee Association for Palliative