Euthanasia Precise definitions are needed

EDITOR, - The paper by B J Ward and P A Tate underlines some of the difficult issues that accompany many of the decisions concerning medical treatment at the end of life.¹ The paper addresses only doctors' difficulties, so is out of step with the modern management of the terminal phase of life: increasingly, this form of care is a team approach and such decisions are the result of discussions among the team. This approach clearly provides benefits and safeguards to both patients and the team.

Discussions about euthanasia, withholding or withdrawing treatments, advance directives, and patients' wishes and autonomy are complex. Precise definitions are therefore required if we are not to confuse important points and issues. The imprecise definitions in Ward and Tate's study tend to blur the issues.

The report of the House of Lords Select Committee on Medical Ethics, in paragraph 21 under the heading “Terminology,” states: “The term passive euthanasia is often used to describe the withdrawal or withholding of some treatment necessary for the continuance of the patient's life. We consider this term to be misleading.”² A BMA working party makes the point: “The qualifiers ‘active' and ‘passive' are often applied to ‘euthanasia' but do not lead to precision in argument.”³ The true definition of euthanasia, again taken from the House of Lords report, is “a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering.”² This should not be confused with the use of appropriate drugs, the intention of which is to obtain adequate control of symptoms, even if these are needed in increasing amounts.

The paper raises many points, such as the need for better training in communication skills, the implications for medical education, and the need for more open discussion. It is regrettable …