BMJ  2005;330:1389 (11 June), doi:10.1136/bmj.330.7504.1389-a

Letter

"Right to die"

...but context of limited resources can be encountered in developed countries too

EDITOR—Grayling writes that it is perhaps characteristic of humankind that it regards reasoned choices about when and how to die as morally problematic, whereas ignoring the question and hoping for the best is seen as acceptable or even right.¹ Vijayashankara (previous letter) reminds us of the need to consider such decisions in the context of limited resources.

This is particularly salient for those who care for the small minority of babies who are receiving mechanical ventilation for inevitably lethal conditions in neonatal intensive care units. A prospective study in 54 such units in the United Kingdom showed that occupancy was linearly related to the odds of risk adjusted mortality.² In other words, the more babies already receiving intensive care in a neonatal intensive care unit, the more likely it was that a newly admitted baby would die. This is likely to reflect the effects of increased staff workload.

If we ignore the question of limiting intensive care when it cannot prevent but only prolong dying, one consequence is that preventable deaths may be more likely to occur.

Children's Hospital at Westmead, Westmead, NSW 2145, Australia williamt{at}westgate.wh.usyd.edu.au

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Competing interests: None declared.

References

1. Grayling AG. "Right to die." BMJ 2005;330: 799. (9 April.)[Free Full Text]
2. Tucker J, for the UK Neonatal Staffing Study Group. Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation. Lancet 2002;359: 99-107.[CrossRef][ISI][Medline]

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"Right to die"

A C Grayling
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