Plumbing the depths

There is a distasteful and unseemly wrangle going on over whether Abdelbaset Megrahi has only three months to live and over the number and qualifications of the doctors who formed the view, and advised the cabinet Secretary for Justice, that this was the case. This downmarket tabloid bandwagon has been jumped on by a series of Scottish Labour and Tory politicians.

The Daily Express’s coverage of the issue can be read here and the Daily Mail’s here.

The Times today has a report which contains the following paragraphs:

‘It emerged that the prognosis that Abdel Baset Ali al-Megrahi had a life expectancy of only three months or less was supported by an unnamed doctor who had no expertise in terminal prostate cancer. The final report on al-Megrahi's condition, which went to Kenny MacAskill, the Justice Secretary, was drawn up by Dr Andrew Fraser, director of health and care with the Scotttish Prison Service.

‘The three-month time limit is important because Scottish Prison Service guidance says that compassionate release from prison “may be considered where a prisoner is suffering from a terminal illness and death is likely to occur soon. There are no fixed time limits but life expectancy of less than three months may be considered an appropriate period”.

‘Dr Fraser’s report says: “Whether or not prognosis is more or less than three months, no specialist ‘would be willing to say’.”

‘Dr Fraser’s report, however, also contains a reference to the “opinion” of an unnamed doctor — thought to be a GP — who, says that the report, “dealt with him prior to, during and following the diagnosis of metastatic prostate cancer”.

‘It adds: “Having seen him during each of these stages, his clinical condition has declined significantly over the last week The clinical assessment, therefore, is that a three-month prognosis is now a reasonable estimate for this patient.”

‘Last night political opponents at Holyrood were claiming that the conclusion reached by Dr Fraser was based on what the unnamed GP had said and had not taken into sufficient account the more guarded views of the prostate cancer specialists. (…)

‘However, the Scottish government has dismissed the claims. A spokesman said that Dr Fraser had arrived at the prognosis based on information provided by all the various medical experts who assessed that Mr al-Megrahi’s condition had declined. He added that the GP was “in close consultation with a highly experienced NHS consultant oncologist of many years’ experience. This view is based upon an analysis of all of the views expressed and the consensus of the medical experts that the condition of Mr al-Megrahi was now entering its final stages.”’

The position is quite simply this. Specialist oncologists simply are not prepared to tell a patient, or anyone else who may want to know, how long that person has to live. They regard their function as being to provide or advise on the best care and treatment for the patient for however long or short a period he may have left to him. This means that if a patient, or anyone else with a need to know, insists on being provided with a time scale, this must be provided, not by the cancer specialists, but by the ordinary general practitioner attending the patient who must do his best, with his overall knowledge of the patient and the progess of the disease, to translate the specialists’ views into weeks or months.

That is precisely what has happened in Abdelbaset Megrahi’s case. The newspapers and politicians who have sought to read something sinister and underhand into the medical aspects of Kenny MacAskill’s decision should be thoroughly ashamed of themselves, particularly that vocal Labour MSP who is himself a medical practitioner.