Joint Committee on the Draft Mental Incapacity Bill Written Evidence


59.Memorandum from Professor David d'Avray (MIB 204)

  My mother was in a coma for six years. After her death I corresponded and talked with Mr M I Hinchliffe of the Official Solicitors office about such situations. I feel I know something about them and hope you will take it into account.

  My mother was not in a vegetative state but she was paralysed and it was unclear how much she understood. Her first consultant (Dr Simpson of Chichester Hospital) did not think it good that she should survive, and refused to treat an infection. (She survived anyway.) However he agreed with the family that nourishment should not be withdrawn. He said that he thought it would cause distress. You need to think through the implications.

  Mr Hinchliffe's view was that patients in a permanent vegetative state suffered not pain, but he added: "I acknowledge that the same may not be the case in relation to patients whose condition falls even slightly short of this." (Letter dated 18 December, 1996). He is a man of integrity whose opinion should carry much weight with you.

  Note that neither Dr Simpson nor Mr Hinchliffe shared my own feeling that it is wrong to intend a patient's death even through inaction. They nevertheless did not deceive themselves about the possibility of distress caused by withdrawing nourishment from patients not in pvs.

  When beds are short in hospitals or when places in a kindly nursing home have financial implications for families there is a danger of doctors and family members assuming too easily that a patient is in pvs: It would be naive to assume that such self-deception is impossible. Even without it mistakes could be made.

  Mr Hinchliffe (tremendously honest and fair despite our disagreements) told me of a case in his personal experience that you should find worrying. Before the coma the person had indicated that they did not wish to be kept alive in circumstances such as actually transpired: a light coma allowing for minimal communication through signals. Mr Hinchliffe visited this patient in his professional capacity and was able to ask what he or she wanted (I forget if it was a man or a woman but he would certainly remember). He told me that he was rather shaken when the patient clearly indicated a wish to be kept alive. This makes me think that living wills are dangerous.

  I suppose that patients in pvs do not suffer when kept alive: what of the others? Having spent so much time with my mother over those six years I can say that quality of life is possible. Her family were able to show her constant affection, she watched tv, the staff of her nursing home treated her as a person. She was aware, followed one with her eyes etc, and my father told me that a day or two before her death she spoke. I suppose her quality of life was much better than that of a severe depressive. There is a lot that can be done with perfumes, ointments, videos etc to make it bearable. You have to have had such a situation in the family to realise how different the whole thing is from situations you see on tv.

  Later one of my acquaintances told me that he had himself been in a coma for a short period after an operation that went wrong. He understood everything that was said around him but had no sense of time. I could put you in touch with him if you wish (he lives in Germany).

  As you can see from the above, the proposed Bill fills me with disquiet.

August 2003





 
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