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

Memorandum by The Royal College of Pathologists

  1.  The Royal College of Pathologists supports the comments submitted by the Academy of Medical Royal Colleges, on which the College is represented. However, the College wishes to draw attention to some specific issues relating to the practice of pathology. The Bill has been discussed by the Executive of the College and is due to be considered at the meeting of the College's Council on 9 September.

  2.  Clause 2(2)(c) requires the attending physician to make "a determination that the patient has a terminal illness". Post-mortem research and clinical audit studies performed in the UK, Europe, USA and many other countries consistently show a c. 30 per cent error rate in the medically certified cause of death. Significant errors (ie misdiagnosis of the terminal illness resulting in inappropriate treatment) occurs in c. five per cent of cases. Therefore, the procedure of making "a determination that the patient has a terminal illness" is not as reliable as the Bill implies. Almost all histopathologists (doctors who perform postmortem examinations) have experience of cases deemed to have died from an untreatable terminal illness, but postmortem examination discloses another condition—that would have been treatable—for the patient's death.

  3.  Clause 2(2)(e) requires the attending physician to inform the patient of his medical diagnosis and prognosis. In view of the above comments about the limited reliability of determinations of diagnosis and prognosis, the patient might also be sensitively apprised of the possible risk of error in making these determinations.

  4.  The College suggests that the Bill deals in a general way with the methods available for assisted dying under this legislation. Clearly the methods should be "humane".

  5.  The Bill does not mention what should be done by way of certification of the cause of death. Since the immediate cause of death would be unnatural (administration of a drug), the death would presumably have to be reported to a Coroner (or, in Scotland, a Procurator Fiscal). Doctors participating in assisted dying should be apprised of the possibility that the Coroner might subject the death to medicolegal scrutiny.

3 September 2004

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