My next door neighbour Clifford was diagnosed with end-stage cancer last year. His oncologist gave him three months to live. He slipped into a deep depression at the thought that he was going to die in the next three months. His carefully-tended lawn and hibiscus plants died, since he stopped tending them. Being elderly, suffering both physically and emotionally, and largely confined to his home, he met all the necessary criteria of the End of Life Choice Bill.
Yet defying his doctors’ expectations, he is still alive – 13 months later. He has even recovered somewhat and now says he has a fantastic quality of life. He has returned to tending his lawn and garden.
This is the true story of my own neighbour. But it’s also a story we all know. Some may have heard of the more famous case of Mr S, a patient from the United Kingdom. He was told his lung cancer was terminal, then made a full recovery after receiving radiotherapy. With classic British understatement, Mr S claimed that the error led to “considerable shock and anguish”.
It seems that almost everyone knows someone who has been given a diagnosis which failed to pan out. Stories like this should give us and our parliamentarians pause for thought when it comes to passing the End of Life Choice Bill. The Bill would make it legal for a doctor to assist a patient’s suicide if that doctor believes a patient has less than six months to live. Yet since doctors get it wrong sometimes, like with my own neighbour Clifford, this Bill would allow some patients to be assisted to commit suicide based on a misdiagnosis or misprognosis.
The Bill’s author David Seymour has implied that he believes medical misdiagnosis is not a problem for his Bill. At a discussion at the University of Auckland on Friday, Seymour stated that it is his honest opinion none will ‘slip through the cracks’ of his Bill. I can only assume that he has not been introduced to the scientific literature on the rates of medical misdiagnosis.
Solid research has confirmed that at least 1 in 20 patients are misdiagnosed (Singh, Meyer & Thomas, 2014). The same study found that different doctors are likely to misdiagnose the same patients as each other, since these patients usually have symptoms which mimic a more serious disease or state. This is actually the conservative estimate. A high-powered meta-analysis into the rates of misdiagnosis around death found that in 45.5% of deaths, the cause of death was something other than what the patient was being treated for (Roulson, Benbow & Hasleton, 2005).
If this Bill were to become law, it should be expected that at least 5% of people euthanised under the law would be victims of misdiagnosis. These people could be expected to have been cured or treated if properly diagnosed. If this Bill is passed into law, many of them will ‘choose’ to die based on a misdiagnosis. Alarmingly, people from ethnic minority groups and people who are poor are misdiagnosed at higher rates than other groups. It would be retrograde to pass a law which will entrench inequality.
We trust the medical profession to get things right when we ourselves become the patient. And based on this research we do get it right most of the time. But it is also obvious that medical professionals get predictions of life expectancy wrong far too often for the End of Life Choice Bill to become law.
Guest post by Callum Hammond, 4th year medical student at the University of Auckland
Roulson, J., Benbow, E., & Hasleton, P. (2005). Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; A meta-analysis and review. Histopathology, 47, 557-559.
Singh, H., Meyer, A., & Thomas, E. (2014). The frequency of diagnostic errors in outpatient care: Estimations from three large observational studies involving US adult populations. BMJ Quality and Safety, 23(9), 727.