A time to live or a time to die?: Summary of responses

EDITOR—The personal view entitled “A time to live or a time to die?”—a reader's tale of how her dying husband has been kept alive by percutaneous endoscopic gastrostomy—sparked a small but impassioned debate on what one correspondent highlights as the right of patients and their families to influence medical treatment.1

Donald Couper, a general practitioner in Manchester, is surprised at the lack of commentary on a theme that must be familiar to doctors working in all types of clinical practice but thinks that fear of legal and disciplinary proceedings may have a bearing on clinical decisions of this kind. Another general practitioner, J Hopkins from Newton Aycliffe, is also certain that the restraint in the case is not medical but legal and advises mature debate about the ethical and legal issues to balance the rights of families against the legal and regulatory framework within which NHS clinical teams are expected to work.

Some correspondents suggest how to improve matters. Herbert Nehrlich, a private practitioner in Australia, for whom being in hospital means to leave one's identity and dignity at reception, only half humorously recommends assigning a “companion” to each hospital inpatient “to reassure, interpret, make conversation, and in general treat you like royalty.” Clive Barker, a general practitioner in Chorley, mentions advance directives as a possible way forward.

The dilemma clearly has no easy solution. One step in the right direction could come from clear and honest communication, say several correspondents. Nigin Bagla and Ritika Mangal from India use personal experience to illustrate what a doctor—in this case a family member—is faced with when treating a patient who is at death's door. And Chris Hudson, consultant geriatrician in Swansea, reminds us that there are two sides to every story and that the problem must have been a failure in communication between family and health-care team.

The consensus is with Naseem Qureshi from Saudia Arabia, that life and death should take their destined journeys. But the matter is obviously not simple. Doctors should never forget that they are human first, then doctors, surgeons, and specialists in sequence—argues Erik Walbeehm, specialist registrar in the Netherlands—and everything else should follow on from that.