Bmj Usa: Editor's Choice

The joy of debate

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E80

This article originally appeared in BMJ USA

The French philosopher Joseph Joubert (1754–1824) said that “It is better to debate a question without settling it than to settle a question without debating it.” Debate is a core component of the culture at the BMJ, where we encourage the expression of opposing views in our internal discussions, in the pages of our journals, and on our web site. By embracing debate, we sharpen our arguments, we improve our decision-making, we enfranchise minority opinions, and we enliven our communication.

One of the most contentious topics of debate in medicine—and society—is physician-assisted suicide. In an editorial in this issue of BMJ USA, Len and Leslie Doyal argue that active euthanasia and physician-assisted suicide should be legalized (BMJ USA p 16). They wrote their commentary after a British court refused a request by Diana Pretty, who suffers from debilitating motor neurone disease, that her husband be allowed to assist her in killing herself. The Doyals believe that active euthanasia is morally equivalent to the withdrawal of life-sustaining treatment from severely incompetent patients when it is “in their best interests.” After publication of their editorial in the BMJ, more than 100 rapid responses were posted on, a sample of which appears on page 19.

This debate is slithering through government circles and the legal system in our own country. On page 52, Marwick reports on the order issued by US Attorney General John Ashcroft in November 2001, that authorizes legal action against physicians who prescribe lethal drugs for terminally ill patients. The policy would overrule Oregon's Death with Dignity Act, prompting Oregon's attorney general to sue the US Justice Department to invalidate the action taken by Ashcroft.

In a simulation study by Grantcharov et al (BMJ USA p 39), surgeons showed impaired speed and accuracy in laparoscopic performance after a night on call. This paper will add fuel to the fiery debate about resident work hours and conditions, which has been heating up. In December 2001, the American Medical Association committed itself to much stronger advocacy on this issue (–5665.html). Congressman John Conyers, Jr (D-MI), has introduced legislation to limit resident work hours (HR 3236). In April 2001, several groups petitioned the Occupational Safety and Heath Administration to promulgate such limits.

Would you like to contribute to these debates, or any others that might be gnawing at you? Stoke the fires on, or contact us directly at BMJ USA.

Doyal (BMJ USA p 16)

Marwick (BMJ USA p 52)

Grantcharov (BMJ USA p 39)

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