Without A Parachute

In which Saatchi Bill rhetoric takes a bit of a nose dive

3rd December 2014

In a piece on Sputnik News today, the Saatchi Bill’s campaign director – Dominic Nutt – responds to criticism of the bill by the Lancet, which follows on from previous criticism by more than 100 oncologists. Actually, he doesn’t respond to the criticism, but instead goes off on a bit of a tangent with a parachute analogy.

“To say to such a patient that a doctor must continue with a treatment that will do nothing to prevent their death — because the treatment will ‘do no harm’ — is ludicrous.

“To state the obvious, if they are dying, then a failure to at least try to prevent their death is the real harm. Put it another way — if you are on a plane that is about to crash and there is a parachute on the door with a label on it which says: ‘do not use this parachute, it has not been tested’ would you deny the passenger the right to grab it? Or would you condemn them to death by crashing?” said Dominic Nutt, a spokesman for Lord Saatchi.

I’m going to spend a few minutes unpicking this, because it is very revealing of the problem, but perhaps not in the way that Mr. Nutt would like.

“To say to such a patient that a doctor must continue with a treatment that will do nothing to prevent their death — because the treatment will ‘do no harm’ — is ludicrous.”

It would indeed be ludicrous, if this were what the medical profession were saying. It is not, and Dominic Nutt is engaging in a straw man argument. What the medical profession is saying is that a treatment decision must be capable of being supported by a sound, logical basis that at least a few colleagues would agree with.

We move on…

“To state the obvious, if they are dying, then a failure to at least try to prevent their death is the real harm. Put it another way — if you are on a plane that is about to crash and there is a parachute on the door with a label on it which says: ‘do not use this parachute, it has not been tested’ would you deny the passenger the right to grab it? Or would you condemn them to death by crashing?” said Dominic Nutt, a spokesman for Lord Saatchi.

Actually, the ability to grab that parachute is pretty much a statement of the law as it stands. No reasonable person would prevent the plane passenger trying the parachute if the plane is about to crash, and handing them the parachute would be an entirely defensible action. Grabbing a parachute, even a potentially faulty one, would be a logical and reasonable thing to do in that situation. Once again, the Saatchi campaign misrepresents the current law by claiming that it prevents reasonable behaviour. What Mr. Nutt claims the bill seeks is actually what the current law allows.

But the analogy is yet more revealing, because it illustrates an underlying deception of the bill, that it’s about what patients are allowed to do, rather than doctors. This is a fundamental conceit of the bill, that it claims to allow patients to demand their doctor try something new, it empowers them to demand to grab the parachute.

But the bill is nothing of the sort. It is in fact about what the doctor would in future be allowed to do, while escaping any consequence for their actions. What the bill actually would do is to allow  illogical and unreasonable actions to be protected by law.

So here’s a better “air crash” description of what the Saatchi Bill would allow to happen.

  • One member of the air crew could replace the parachutes with plastic coffee stirrers. As long as they discuss the change with other members of the crew, they are not negligent to do so. They require no agreement from other members of the crew.
  • On encountering turbulence, one member of the air crew could scream “the plane is crashing!” and advise all the passengers to bail out. It does not matter whether the plane is actually crashing, as long as they discuss the decision to advise passengers to jump.
  • One member of the air crew could advise passengers to jump from the plane at 35,000 feet. This could be contrary to established guidelines that state the plane must be below a certain altitude to prevent passengers being sucked from the plane and to prevent asphyxiation, but as long as the crew member has discussed and obtained the views of their colleagues, they can still continue.
  • The plane is crashing. Instead of parachutes, the flight attendant supplies bottles of water from the drinks trolley, which they describe as “homeopathic parachute 30C” at a price of £50,000. Again, as long as they have consulted a colleague about this change, they do not require agreement.
  • The plane is crashing. The flight attendant refuses to hand over a parachute to a particular passenger, saying that they are not a suitable candidate for one. Although this is against guidelines that say that the passenger should be supplied a parachute, the decision to depart from the accepted range of actions is protected because the flight attendant discussed it with another member of the crew.

Remember, the Saatchi Bill is about – and is only about – defending decisions made by doctors that none of their colleagues would support. If those decisions were supportable, they would already have the protection of Bolam/Bolitho, and wouldn’t need the bill. In the aeroplane analogy, it is like one member of the flight crew making decisions about the parachutes that no colleague agrees is a good idea.

Which means that the choice of parachutes as an analogy is an inadvertently appropriate one, since what the bill would achieve is depriving patients of any protection if their treatment goes wrong. It takes away the parachute they could use to protect themselves if something breaks or the pilot crashes their plane.

The Saatchi campaign continues to nosedive under the weight of its misleading rhetoric.

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Edit 3/12/14: It has been pointed out to me that I have neglected to reference the following research paper BMJ 2003;327:1459 when compiling this article. I thank the colleague who kindly pointed out the omission, and will find a suitable way to repay him. Oh yes, a suitable way.

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5 Responses to “Without A Parachute”

  1. stopthequacks December 3, 2014 at 11:33 pm #

    The idea that someone with a terminal illness can’t have further harm done to them which would be inhumane, possible cause increased pain and suffering and a further reduction in their quality of life, is breathtaking. To argue that pretty much anything can be tried if someone argues there might be a benefit is incredible. How the bill has got this far paints a sad picture of how a concept that may start from a good intention can be perverted to lead to something that will inevitably cause increased harm. The bill is totally unnecessary, and is a quacks charter, a huge step backwards.

  2. wanderingteacake December 4, 2014 at 3:33 pm #

    I currently have a long comment in moderation from a parent and supporter of the bill, and I am considering what to do next. I don’t normally allow essay-length comments here, and instead recommend the commenter blogs their views separately, posting a link to those comments here.

    This commenter has made some heartfelt points but, I feel, has also misunderstood my viewpoint and the aim of this blog. I would emphasise that I do not support continuing with the medical status quo. There are manifest problems with the development of new treatments. I simply maintain that this bill will not solve any of those problems, but it will generate some new ones and lead to patient harm.

    I recommend reading the other Saatchi Bill posts here on my blog and on http://www.stopthesaatchibill.co.uk/ and also my Guardian articles

    http://www.theguardian.com/science/brain-flapping/2014/may/21/saatchi-medical-innovation-bill-patients-quacks-treatments

    http://www.theguardian.com/science/brain-flapping/2014/nov/19/saatchi-bill-medical-innovation

    I understand that responding to a comment I haven’t yet published is a little asymmetric, and hope to reach a suitable decision that is fair to the commenter as soon as possible.

    • wanderingteacake January 30, 2015 at 10:28 am #

      Update: I did manage briefly to establish a dialogue with the person referred to in my comment above. We discussed their concerns, and they promised to get back to me after reflecting on our discussion, and reading some articles I provided. I have heard nothing since and so must regretfully conclude that the conversation is unlikely to resume. For that reason, the comment will remain in moderation.

  3. James December 9, 2014 at 5:20 pm #

    “If you are on a plane that is about to crash and there is a parachute on the door with a label on it which says: ‘do not use this parachute, it has not been tested’ would you deny the passenger the right to grab it?”

    What if you already know the parachute has been cut in half and all the cords are missing?

    How about only allowing parachutes which have been tested and shown to work to be put on planes in the first place?

  4. Michael Baum December 12, 2014 at 5:03 pm #

    The analogy is seriously flawed for all sorts of reasons. If your plane is nose diving then you expectation of life is about 60 seconds from 30,000 ft. The only evidence based solution is indeed a parachute.
    If you have terminal cancer your expectation of life is a median of 60 days. Those days can be shortened and ruined by an ignorance based experiment. In fact if the patient put on a parachute and jumped out their window the their expectation of life would be reduced to 60 secs.

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