54.Memorandum from Dr John Scotson (MIB
1. I write as a retired medical practitioner
who has cared for many dying patients. I take a special interest
in this Draft Mental Incapacity Bill in so far as it could affect
the care given to the dying and could be used to bring human lives
to a premature end, empowering or enforcing medical attendants
to abstain from giving that care to which all dying people are
entitled. Moreover the Bill is dangerous in the extreme, m so
far as the law affects attitudes, because if it becomes law respect
for human life will further diminish, doctors attending patients
who have made living wills will on occasions be hampered for doing
what they know to be in the best interests of the patient.
2. It is important to bear in mind some
devastating events which have occurred in the last century and
the beginning of this century in the hope that they that they
may not continue or be repeated.
3. During the past century and the beginning
of this century lives both of the bom and unbom have been needlessly
taken; killing has been legalised, witness the epidemic of abortionsabout
six million abortions performed since the abortion act in 1968.
Doctors m the Netherlands, where euthanasia has become commonplace,
have co-operated in the suicides of people with early-stage HIV,
anorexia and depression. A number of doctors in the Netherlands
admit to killing patients without obtaining prior consent. In
the course of the euthanasia "action" programme carried
out in Nazi Germany more than 80,000 mental patients had been
gassed between September 1939 and August 1941.
It is sometimes erroneously believed that the atrocities which
have happened in the past cannot be repeated in this country:
however all human societies and all individuals are capable of
both great humanitarian acts and also evil acts mainly by doing
harm to others. We must safeguard our laws and our society with
the utmost vigilance not allowing any practices to be legalised
which will result in harm or death to others.
4. In respect of this Draft Bill certain
aspects merit special consideration. First: it is of paramount
importance to understand that wishes expressed by the healthy
in respect of action or inaction to be adopted when they are in
a terminal, critical or unhealthy condition are not usually their
wishes when that condition has been reached as any member of the
medical or nursing professions will attest. Attitudes change when
a patient changes from a healthy individual to one who is ill.
As has been stated "Euthanasia is a minority interest amongst
the terminally ill." To illustrate the point one recalls
the conversation in the old persons home when it is agreed among
the residents that none of them, bar one, would wish to live to
the age of 100. The one who dissents is age 99.
5. Hypothetical situations described to
those invited to make living wills and advance decisions, which
will not have to be registered and can be made orally, are fraught
with dangers both for the future patients and their doctors. For
instance conditions such as Persistent Vegetative State may be
described to a person following which the person may be asked
what would their wishes be if they became locked into this state.
However the term vegetative applied to human life is inappropriate,
implying as it does that the person has ceased to be a human being.
Dr Keith Andrews writing in the Journal of the Royal Society of
Medicine said "in our own unit, 40 per cent of Those with
a diagnosis of vegetative state were found to be have been misdiagnosed,
some for several years".Some
patients in the supposed vegetative state have recoveredfor
example: a person named Patsy White Bull, an American Indian mother
of four recovered after 16 years in coma in December 2000Medical
conditions thought to be irreversible are on occasions proved
to be otherwise.
6. While killing must always be abhorrent
to a civilised society needless or burdensome treatment need not
be given and should not be given to those who are dying. Nonetheless
ordinary care and attention including the giving of food and fluid,
on which all human life depends, must always be given. The exceptions
to the rule of giving fluid is when death is imminent and the
benefit of giving fluid would have no value. Death by dehydration
is painful in the extreme. To see a patient who has a completely
dry infected mouth and inelastic skin is to understand the intense
suffering to which they are subjected.
7. It must be understood that the phrase
"artificial nutrition and hydration" is a nonsense in
so far as the administration of food and fluid, however administered,
can never be deemed artificial or constitute medical treatment.
In the same way as oxygen cannot be described as artificial if
administered by a face mask. Where a patient is denied administration
of food and fluid and dies of dehydration or malnutrition that
patient will have been deliberately killed and will not die because
of the underlying disease but of dehydration and malnutrition.
The ethical principle is that nothing should be done with the
deliberate intention of killing the patient.
8. The commandment "you shall not kill"
and the Hippocratic teaching"I will use my power to
help the sick to the best of my ability and judgement; I will
abstain from harming or wronging any man by it. I will not give
a fatal draught to anyone if I am asked; nor will I suggest any
such thing" could be undermined if this Bill becomes law.
The attending doctor could be prevented from using his/her powers
to help the sick, mentally affected and the dying through a wish
previously expressed either orally or in writing conceming a future
hypothetical situation. This "wish" could be expressed
by a third party on behalf of the patienta situation which
is open to abuse. The Bill, if adopted, would lead to the widespread
practice of eugenics and euthanasia.
1 Second World War Martin Gilbert Chap 17 p 228. Back
Vegetative State-background and ethics J R Soc Med 1997 90 593-596. Back
Sunday Telegraph 9 January 2000 p 24. Back