Monday, 3 April 2017

We should be proud of Al-Megrahi’s doctors

[This is the headline over an article by Dr Jim Swire that appeared in the British Medical Journal on this date in 2010:]

In December 1988 a Boeing 747 was destroyed by a bomb in a baggage container in its hold at 9500m over Lockerbie, 38 minutes after leaving Heathrow, where it had been loaded from empty. The criminal investigation was placed in the hands of the United Kingdom’s smallest police force, Dumfries and Galloway.

By May 2000 the investigation, following the lead of a random selection of clothing found at the crash site and originating in Malta, believed that the bomb had also entered the aviation chain there, aboard an Air Malta flight, placed by Abdelbaset Al-Megrahi, a Libyan. A trial began at Zeist, near Utrecht.

Despite Air Malta’s denials of being the initial carrier, reinforced by substantial payments to them from a UK television company that had repeated that story on air, and despite the lack of any evidence in court as to how Al-Megrahi was supposed to have breached security at Luqa airport in Malta, he was found guilty. Then on the failure of his first appeal in Zeist in 2002 he was transferred to a Scottish prison.

Only during that first appeal was it revealed that, unlike at Luqa, where there was no evidence of any failure of security, the perimeter at Heathrow had been broken through the night before Lockerbie, close to where the container, in which the bomb exploded, was loaded. No effort had been made to discover the intruder or their motivation, despite the immediate logging of the “incident” by Heathrow staff.

There was no jury in the appeal; amazingly the verdict still stood. The official United Nations observer, Hans Kochler of Vienna; the Scottish law professor Robert Black of Edinburgh; and many others, including me (I attended at Zeist throughout) doubt that the verdict should have been reached. In Scotland, too, public opinion is deeply divided.

In view of these and other remarkable weaknesses in the trial it was little surprise when the Scottish Criminal Case Review Commission decided in 2007, after four years’ delay, that the whole thing may have been a miscarriage of justice and referred the case back for a second appeal.

By August 2009 Al-Megrahi, now aged 57, was gravely ill and in pain. It was widely known that he had metastatic prostate cancer, with substantial skeletal secondaries. Under a precedent in Scottish law that terminally ill patients could be granted “compassionate release” if they were believed to have only a few months to live, Al-Megrahi—who still proclaimed his innocence—was released to his home in Tripoli by Kenny MacAskill, the Scottish justice secretary.

There were shouts of fury from those who had not looked at the evidence for themselves. Some of these were the same voices who had urged that analgesics should be withheld from the suffering prisoner; one wrote to me that he hoped Al-Megrahi’s death would be a long drawn out agony.

MacAskill had taken the advice of the prison medical service in Greenock prison, which in turn had called in two Scottish consultants; and he was also advised by a prominent professor of oncology. This oncologist was apparently accompanied by two other, English, doctors. I understand that all doctors involved conferred before advising MacAskill that a likely prognosis for Al-Megrahi was about three months.

But two major changes have taken place since then. Firstly, Al-Megrahi has been returned to his own country and is with his own loving family. We know that a major reduction in stress will sometimes induce a major remission, even in a terrible progressive illness such as his.

Secondly, he has undergone a course of treatment in Tripoli with one of the taxol series of drugs, together with palliative radiotherapy. These can be associated with remissions of many months. Presumably they had not been given in Scotland, for some reason.

Now that he has survived for seven months, allegations are appearing in the media that this man’s illness was fabricated or at least exaggerated for some political or economic motive and that the doctors must have been “bought.”

My own medical knowledge of the case is confined to meeting Al-Megrahi in prison and observing his physical decline and is without any professional involvement, except for discussion with the oncologist. Nevertheless I wish to support the advice that my distinguished medical colleagues gave to MacAskill. BMJ readers will be able to confirm that the two major changes in Al-Megrahi’s circumstances might well explain the dramatic and welcome improvement in his condition.

In any case, “How long have I got, doc?” was never a question to which I knew a precise answer as a GP; seldom are a doctor’s humanity and tact more tested.

The prognosis delivered by our doctors in this fraught case helped to precipitate a major crisis in the UK-US alliance, in which President Barack Obama and Hillary Clinton were both to express their great displeasure. But by sticking to their patient oriented professional duty, the doctors contributed to a major relief for a dying man. We should be proud of them.

When I last met this quiet and dignified Muslim in his Greenock cell he had prepared a Christmas card for me. On it he had written, “To Doctor Swire and family, please pray for me and my family.” It is a treasured possession by which I shall always remember him. Even out of such death and destruction comes a message of hope and reconciliation for Easter.

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