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
conditionthat would have been treatablefor 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
|