EDITOR,—There is more to some advance directives than the extension of autonomy by a once competent patient. That of the Voluntary Euthanasia Society, for example, requires that insulin is withheld when required from a signatory who develops presenile dementia. If that advance directive were legally enforceable the doctor would have to give way to a patient's wish to have death brought forward by unreasonable measures.

Len Doyal1 does not mention a serious deficiency …