A conscience vote

Two of Scotland's churches have called for votes on al-Megrahi to be conscience votes. I think we should check that they all have a conscience first.

I wasn't surprised that an embittered former Labour spin-doctor would be rubbing his hands in anticipation of some slight party political advantage rising from the end of a man's life, but I was shocked to see that a Labour medical doctor (still doing locum work while an MSP, apparently) would. Dr Richard Simpson, Labour MSP, joined in Labour's gruesome sweepie.

The Scotsman article says

In parliament on Monday, Dr Simpson said that his reading of the notes suggested Megrahi may have eight months left, not the three months or less on which Mr MacAskill said he based his decision.

Allow me to help him with the reading of those notes, section 4e:

The clinical assessment, therefore, is that a 3 month prognosis is now a reasonable estimate for this patient.

That was at the beginning of this month. I don't believe that Richard Simpson is incapable of reading this report, so I can only assume that he is being deliberately obtuse in order to mislead. There is further evidence; Dr Simpson is quoted in the Scotsman saying

Kenny MacAskill released him apparently on the advice of just one doctor, whose status is not clear and who is not named.

Well, if you go back to the notes (linked above), you'll see that Section 4 was to be completed by the Medical Officer and that two consultant oncologists and two consultant urologists were engaged. In addition, there was a palliative care team and other specialists who contributed. I wondered who the Medical Officer was - I found it in the Official Report of the Scottish Parliament where Kenny MacAskill was responding to - wait for it - Dr Richard Simpson:

Kenny MacAskill: I followed the three-month rule. That was the medical information given to me. The medical report from the Scottish Prison Service's director of health and social care was dated 10 August and was based on an interview and examination of Mr al-Megrahi on 3 August, when it was made clear that there had been a change for the worse in his circumstances. I do not have the benefit of Dr Simpson's training in medicine or psychiatry, but I follow the rules and guidance that are laid down for cabinet secretaries for justice. I recall that Dr Simpson, too, has served as a justice minister. I followed the same rules and regulations that he would have been required to follow had the issue come before him.

The Director of Health and Social Care at SPS is Dr Andrew Fraser who was Deputy Chief Medical Officer at the then Scottish Executive while Dr Richard Simpson was a Minister. Dr Simpson wasn't finished there, either, he went on:

"At the very least, before agreeing to release a prisoner convicted of such a serious crime on compassionate grounds, the minister should have sought a second opinion confirming the patient's prognosis from a specialist in palliative care."

As I've said already, there was a palliative care team as well as the four consultants and the Director of Health and Social Care - which of these is Dr Simpson seeking to discredit? He should hang his head in shame both as a politician and as a medical professional.

Not that the Scotsman is blameless - the article claims that "The report suggests that only one doctor was willing to support the claim that Megrahi had just weeks to live" - no it doesn't. The article also says that

the summary said: "Whether or not prognosis is more or less than three months, no specialist would be willing to say."

Firstly, there is no summary, this is the section filled in by the Medical Officer as part of the overall report. Secondly, put that quote back into context and its meaning is substantially changed:

In June and July 2009, assessment by a range of specialists reached firm consensus that the disease was, after several different trials of treatment, "hormone resistant" - that is,
resistant to any treatment options of known effectiveness. Consensus on prognosis, therefore, has now moved to the lower end of expectations from 10 months ago. Reviewing the total picture, the concluding specialist view is that, in the absence of a good response to treatment, survival could be in the order of 'months' and, no longer 'many months'. Whether or not prognosis is more or less than 3 months, no specialist "would be willing to say".
In the opinion of his [redacted] who has dealt with him prior to, during and following the diagnosis 0f metastatic prostate cancer, and having seen him during each of these stages, his clinical condition has declined significantly over the last week (period 26 July-3 August). The clinical assessment, therefore, is that a 3 month prognosis is now a
reasonable estimate for this patient.

It's clear that the 3 month prognosis was a development from the previous collective opinion which was quite clearly not a surprise. Metastatic cancer, by the way, is when it has spread to other parts of the body. The Scotsman also said:

There was also a suggestion that Megrahi might not be as ill as had been claimed. The report said: "Clinicians who have assessed Mr Megrahi have commented on his relative lack of symptoms when considering the severity and stage of underlying disease."

The quote's right, but the interpretation put on it by the Scotsman isn't; that quote doesn't suggest that he's less ill than claimed, it suggests that he's more ill than he appears - his symptoms are not matching the condition of his disease.

Then there was the whiff of xenophobia:

And suggestions that the doctor who gave the prognosis may have been employed by the Libyan government emerged in the report's notes. It said that a professor from Libya had been involved in Megrahi's care and the medical officer who wrote the report had been "working with clinicians from Libya over the past ten months"

The quote is slightly wrong, but not enough to change the meaning substantially. There is no suggestion in the report that it was a Libyan who gave the prognosis. The idea that Scottish doctors were excluded is pretty stupid, isn't it? The implied allegation that a Libyan doctor would lie about a patient's condition is disgusting as well. In fact, a wee look up the page and this bit would have been obvious:

Mr Megrahi has undergone specialist consultations with a variety of medical consultants from across the UK and Libya. There has been, throughout the course of his illness, substantial.consensus between both visiting and "home" specialists on matters of diagnosis, treatment and prognosis.

Casting aspersions on dedicated professionals, adding in a bit of casual xenophobia, and topping it off with a sprinkling of misdirection - not a recipe for decency from Labour and the Scotsman. I do hope they'll both reflect on that, this is the last weeks of someone's life, not a topic for a ya-boo kickabout, a bit of common human decency wouldn't go amiss.