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

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 cited above).

  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 numbers.

  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 disagree?

    —  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 suicide.

  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), FRCP (Lond)

  Chair of Ethics Committee Association for Palliative Medicine

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