The choice to live or die should remain to the end

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6992.1467a (Published 03 June 1995) Cite this as: BMJ 1995;310:1467
  1. Liam Farrell
  1. General practitioner Crossmaglen Health Centre, County Armagh BT35 9HD

    EDITOR,—It is ironic that euthanasia should be causing renewed controversy at a time when our skills at controlling symptoms have never been greater.

    Criticising the palliative care movement is the medical equivalent of kicking a spaniel, but on The Late Show, which discussed the televised mercy killing of a patient in Holland,1 Cicely Saunders and Nigel Sykes managed to be patronising and insensitive to both our Dutch colleagues and our patients. To insist that patients asking for euthanasia are really asking for something else is a self deluding paternalism. Their rationale seemed to be that any wish to die represented a misapprehension which could be corrected by quality palliative care. This may be true in many cases; fear of dying in pain or alone or in distress is responsible for many patients wishing to die, and we can reassure these patients that their fears are largely groundless. Palliative medicine should be a core subject for all hands-on doctors, and should apply to all terminally ill patients, including those who are not dying from cancer. Even so, no matter how skilled the care, some patients will experience extreme suffering which can be relieved in only one way.

    Some of the sophisticated methods for estimating quality of life, which are based on several measures, such as degree of disability and discomfort, can actually show a minus score—literally, a fate worse than death. Would a request from such a patient seem reasonable?

    Of course we will have to protect our patients from abuses—the Thatcherite distaste for the old, the sick, the vulnerable, and the uneconomic increasingly pervades the health service, and euthanasia would be a tremendously attractive option to the paymasters; but then we doctors are well used to combating these dark forces.

    Life is a matter of choice and that choice should remain ours to the end. Applying broad ambiguous ethical principles to individual tragedies is casuistry of the most pernicious form. If the conflict is between societies' ethical, moral, and legal codes and a doctor's compassion for the patient; if the dilemma is between respect for life and respect for a life, then there can be no reservation of justice.


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