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Parliament

Voluntary EuthanasiaIN the House of Lords on Nov. 28 Lord CHORLEY

asked the Government at any rate to accept the principleof voluntary euthanasia so that legislation could beintroduced in due course. He suggested that euthanasiamight be granted on the following conditions :The sufferer must be not less than 21 years of age, of sound

mind, and suffering from an incurable and fatal illness involv-ing severe pain. He must make application in writing on aform signed in the presence of two witnesses. The applica-tion must be supported by two medical certificates one fromthe applicant’s own doctor and the other from a doctorwith special qualifications for dealing with these cases ;the application must be made to a referee appointed by theMinister of Health, and the referee must personally see thesufferer to ensure that the conditions had been fulfilled andthat the patient fully understood the nature and purpose ofthe application. Euthanasia would be administered by adoctor from a special panel maintained for the purpose.The ARCHBISHOP OF YORK opposed the proposal not

through lack of sympathy but for religious and socialreasons. He could not criticise the doctor who. with a fullsense of responsibility, alleviated pain, even if by so doinghe shortened the life of a patient dying from an incurabledisease. But this, he felt, was entirely different frompassing legislation on the subject. It would be a seriousmatter if for the first time there appeared on the statute-book a law which gave certain people licence to kill

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some of their fellow men and women. Capital punish-ment was justified only because it was the vindicationof the sacredness of human life. If once legislation ofthis kind was allowed, where were we to stop ? Whyshould it .not apply to the feeble-minded, the physicallycrippled, and those in mental asylums ?Lord HORDER hoped that the decision would not lie

with the doctor. Putting an end to human life involveda new principle in biological control, so foreign to thegeneral sense of the community that he would be verysurprised if it were accepted in Lord Chorley’s lifetime,or ever. A good doctor, in Lord Dawson’s words,distinguished between prolonging life and prolonging theact of dying. Any sanction which would reverse thedoctor’s function-to cure the patient’s disease or

prolong his life so far as might be-would not be in thepublic interest.Turning to the criteria laid down by euthanasia

advocates, Lord Horder pointed out that the disease whichwas incurable today might be cured next year. Againthe threshold of pain varied enormously in differentpatients and only the experienced doctor could judgehow much pain was being suffered. There had neverbeen so many means of alleviating pain as today. Illness,and even pain. for many people constituted a newexperience, unhappy, but possessing spiritual significanceand value. To call the function of a doctor who helpeda patient to achieve that degree of elevation of spiritan intolerable burden seemed to Lord Horder to be dis-paraging one of the very important duties that a doctor

’ had to perform. The two extremes of dying in painand being killed did not exhaust the possibilities of thestricken patient. There was a middle position achievedagain and again by a kindly and skilful doctor who gaveassistance to a fellow human being who had become anintimate friend. A further criterion was that the patientmust be of sound mind. but there was no less difficultyin judging the patient’s state of mind than in assessingthe amount of his pain and the incurability of his disease.The mind of the patient suffering from a lethal illnesswas not unsound in a legal sense, but it was uncertainand fitful, variable, and with little certainty or clearness(,f purpose. If euthanasia were introduced Lord Horderfeared that old people might avail themselves of it, orthink they ought to do so, because they felt they wereencumbering the ground and would like to make roomfor someone else.Lord AMULREE pointed out the change that a law of

this sort would make in the atmosphere of the sick-room. At present the patient was convinced that thedoctors and nurses were doing their best, to alleviate

his pain. If a patient felt that one day the doctor wouldcome in as executioner, even though the patient mightlong to end his life himself because of pain, Lord Amulreedid not think that it would lead to an improvementin the relations between doctor and patient. LordUvEDALE held that there were few cases at present where.euthanasia should be contemplated, and these cases

would become fewer still as new remedies were introduced.The matter should be approached with great cautionremembering with all humility that euthanasia wasan admission of failure and a counsel of despair.Lord HADEN-GUEST reported that at the meeting of

the World Medical Association in Scandinavia this springa resolution was passed against euthanasia. The associa-tion represented doctors from every country in the worldwhich chose to send delegates, and he thought it mightbe said that the vast majority of medical opinion in thewhole world was against euthanasia. The vast! majorityof doctors in this country felt that whoever else wasgoing to administer euthanasia, it was not they. Thesuggestion that the business of euthanasia should be putin their hands, that they should meet round the bedsideof a patient and give him some injection to cause death,was to them a dishonourable suggestion.Lord WEBB-JOHNSON also thought the idea of euthan-

asia was dreadful when one had spent a lifetime in takingrisks to save human life. He cited instances of severalincurable diseases which had lately become curable.Were they to contemplate the situation in the sick-room where an elderly patient with a chronic illnesslooked round with suspicion and accepted everysuggestion such as : "How can you bear all this ? "

or " Don’t you wish it was over ? " as a suggestion that

he should apply for the appropriate form and fill it in ?Moreover, suppose, quite clearly on his own initiative,the patient put forward a request for release ; was notto agree to that request legalising suicide ? Lord Webb-Johnson thought it was.Lord J OWITT, the Lord Chancellor, said that from the

legal point of view the consequences of passing a Billof this kind would be grave and serious. The doctrineof what was called putting people out of their miseryfor the reasons which had been advanced might haveserious repercussions on the criminal law of the land.The introduction of a Bill, no matter what the safe-guards might be, wou d be wrong, because there couldbe no adequate safeguards when they allowed one humanbeing to start killing another. Once they departed fromthe doctrine of the sanctity of human life they wouldindeed be on the slippery slope.

QUESTION TIME

Registrar AppointmentsMr. J. K. VAUGHAN-MORGAN asked the Minister of Health

whether he would withdraw his proposals for an immediatecut in hospital registrar establishments, with a view to puttingforward an alternative scheme which would cause less hardshipto those concerned, particularly those trainees whose careershad already been seriously affected by their war service.- Mr. A. BEVAN replied : This circular, which has been grosslymisrepresented, was issued after full consultation with theprofession’s representatives. Its object is in the interests ofthe profession itself-to secure a proper relationship betweenthe numbers of training posts for future specialists and thenumber of specialist posts likely to be available. In estimatingthe latter it allows for a reasonable annual expansion over andabove mere replacements in present posts, and the numbersof training posts will be reviewed as and when further

expansion occurs in later years. The urgency of the circularis that the number of trainees has already risen to nearlytwice the number needed to produce the specialists likely tobe required and about four times the pre-war number, asituation thoroughly unfair to all concerned. The circularwas not prompted by economy-indeed, it provides foralternative appointments if necessary for the work of the

hospital.Mr. VAUGHAN-MORGAN: What prospects of suitable

employment are open to those 1100 hospital registrars whowould become redundant as the result of the proposed cutin establishment over and above the 700 appointments whichare vacant in the Services and Colonial Medical Services.—Mr. BEVAN : Each existing senior registrar and registrarwill complete his present year of appointment. Afterwards

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a senior registrar whose appointment is not renewed but whoseservices are still needed may be offered a similar temporaryhospital appointment for one year. Others and registrarscan-as has always been the case where appointments inthese training grades have not been renewed-apply to setup in general practice, possibly supplemented by a part-timeclinical assistantship at a hospital, or for appointments incivilian medical practice in this country as well as in thefields referred to by the hon. Member, or for university andhospital appointments abroad.

Replying to Mr. Henry Brooke, Mr. Bevan said that thenumber of posts of registrar and senior registrar which wouldbe abolished in hospitals in the North-West Metropolitanregion if his recent circular was fully implemented wasabout 240 and 290 respectively (including the figures for theteaching hospitals in the area).

Beds in Tuberculosis Sanatoria

Mr. SOMERVILLE HASTINGS asked the Minister what wasthe number of beds reserved for the treatment of pulmonarytuberculosis in sanatoria, general hospitals, and fever hospitals,respectively, which were now empty because of shortage ofnursing and domestic staff ; what was the number of bedsat present reserved for the treatment of pulmonary tubercu-losis in sanatoria, general hospitals, and fever hospitals,respectively.-Mr. BEVAN replied : The number of tuberculosisbeds provided in institutions classed as sanatoria and tubercu-losis hospitals is about 27,700, of which about 44-00 are

unstaffed. There are some 3500 staffed tuberculosis beds inother hospitals. Of the 31,200 staffed beds approximately27,200 are for pulmonary and 4000 for non-pulmonarytuberculosis.

Service PayIn answer to a question, Mr. EMANUEL SHINWELL stated

that increases in pay had been approved for medical anddental officers of the three Services. In addition there will beincreases in specialist pay for medical and dental specialistsin the Royal Navy and Army ; in the Royal Air Force specialist

qualifications will continue to be recognised by a system ofaccelerated promotion. The increased rates will not apply toNational Service officers until they have completed 18 months’whole-time service. The increases and new rates, which willtake effect from Sept. 1, 1950, are as follows :

BASIC PAY

National Service Medical ExemptionsIn answer to a question Mr. G. A. ISAACS, Minister of

Labour, said the numbers of men exempted from nationalservice on medical grounds from 1946 to 1949 and those

exempted this year were as follows:Number exempted from NationalSerrice on medical grounds.*

1946 ........ 39,9641947 ........ 24,6481948 ........ 24,7111949 ........ 33,8181950 (to Sept. 28) .... 34,506

* Excluding men not examined-e.g., the blind and limbless.

Obituary

WILLIAM WILLIS DALZIEL THOMSON

KT., B.A. R.U.I., M.D., B.SC. Belf., F.R.C.P.Sir William Thomson, professor of medicine in Queen’s

University, Belfast, and its representative on the GeneralMedical Council, died on Nov. 26, at the age of 65.A son of the late Dr. W. Thomson, J.P., of Anahilt

House, Hillsborough, co. Down, he was educated atCampbell College, Belfast, and later at the Queen’sUniversity. The whole of his academic career was asuccession of brilliant achievements. In 1906 he wonthe Henry Hutchinson Stewart scholarship of the RoyalUniversity of Ireland, and in the following year, -aftergaining the Dunville studentship and senior scholarshipin chemistry at Queen’s University, he graduated B.A.with first-class honours. In 1919 he obtained his medicalqualifications in Queen’s, again with first-class honours,which then, as now, was a rare achievement.

His first teaching post at Queen’s was in the physiologydepartment, from which he went on to be Riddelluemonsuaùor in paunoiogy.During this period he added aB.sc. to his name, again withfirst-class honours. He travelledabroad and studied in Paris andBudapest. After this he carriedon his research work while liewas with the R.A.M.C. in theB.E.F., attached to Sir AlmrothWright’s laboratory. Later heused to recall how in those earlydays they did blood-trans-fusions without grouping. Onsoldiers suffering from trench

nephritis the first blood-ureaswere done, and in these waryears Thomson did the firstseries of blood-urea estimationsin prostatic obstruction. Henever published these, but hiswork on war nephritis appeared in 1918. In 1916.he had obtained an M.D. with gold medal, thus com-pleting an academic career whose lustre has rarelyif ever been equalled in the annals of Queen’s University.

It was only natural that a man of his attainmentsshould serve in the. teaching of others, and shortly afterhis return to Belfast, in 1923, he was appointed professorof medicine. Five years later he was elected a fellowof the Royal College of Physicians of London. Heserved on the staff of the Mater Hospital before hisappointment as assistant physician to the Royal VictoriaHospital in 1918. He became full physician in 1923-24when he was given charge of wards. He had the raregift in teaching of making difficult. subjects plain to thoseless gifted, and his clinical lectures and demonstrationsin the Royal Victoria Hospital were always crowdedwith eager students.Though serious illness. which developed soon after he

had been appointed professor, threatened for a time twocut short his career, he recovered and once more resumedhis teaching and his hospital and private practice.Besides his work on war nephritis, he published paperson bronchial carcinoma and the renal aspects of essentialhypertension. In 1939 he delivered the Lumleian lecturesbefore the Royal College of Physicians, choosing as hissubject Primary Carcinoma of the Lung.