Page 3212 - Week 11 - Wednesday, 21 September 1994
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start exploring what is meant by that particular definition and where it is repeated in clause 22, you have to ask, "Where is the line, and how does Mr Connolly know where the line is?". He does not know; but he was clearly concerned about it, so he has come up with his own amendment. Now he says "to ensure the right of patients to receive relief from pain and suffering to the maximum extent that is reasonable in the circumstances".
I think that Mr Moore's intention was quite clear; but who is now to judge what is reasonable in the circumstances? Is it the patient? If the patient is unconscious, it cannot be the patient. Is it the nurse that happens to be on duty in the ward? How does she determine what is reasonable in the circumstances? We have heard quite recently of circumstances in hospitals where nurses are run off their feet and some patients do not receive even the most basic of care over short periods of time while the nurses are tied up with more urgent cases. We had evidence presented on this quite recently. So what is reasonable? If the nurse in the ward is busy taking care of a patient somewhere else in the ward who is having difficulty and this particular patient is unconscious, is she safe in saying, "Well, at the time I thought it was reasonable to focus my attention on other patients", even though this patient may have needed treatment?
I do not know how you determine what is reasonable and I do not know how the health professionals that are dealing with these people are going to know. There may be a relative sitting by the bedside. If the nurse is too busy to pay any attention to the patient and the relative says, "We need more treatment for my aunt", is the nurse going to say, "You are wrong. I do not have time to worry about that."? This measure of what is reasonable is totally unreasonable when you are dealing with the life or death of a patient. So, in my view, Mr Connolly's amendment to the clause makes even less clear what is the duty of the medical practitioners and the health professionals that are taking care of these patients. Where does their duty lie and how do they know whether their action might be judged by somebody else, at a later time, to be reasonable?
To come back to Mr Moore's intention, if being reasonable is to inject morphine or some other drug into a patient to the point where they die, is that reasonable? I submit that, as in many other things, individuals have different reactions to specific doses of treatment. Some of us could probably take greater amounts of drugs than others because of our bodily bulk or because of our state of health at the time. So who is to judge what is reasonable? This is the very thing that troubles me. It is the reason why I raised the question when we were dealing with the definitional clause of the Bill. It leaves open the question of what is reasonable. There are no objective criteria set down in this Bill to determine what is reasonable. That means that it is entirely subjective. It does not even say who is to make that subjective judgment. If it cannot be the patient, who is going to make it?
If there is a written direction, perhaps there is some clear understanding on the part of health professionals of what they should or should not do; but, if there is not one, where are the criteria and where does the responsibility lie for saying, "We will or we will not provide additional treatment", and on the other hand, "We are all too busy taking care of a heart attack victim up the other end of the ward and we do not at the moment have
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