BMJ  2003;327:E85-E86 (4 October), doi:10.1136/bmjusa.02010002 (published 4 September 2002)

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

This article originally appeared in BMJ USA

As of December 19, 107 rapid responses had been posted on bmj.com in response to the editorial by Doyal and Doyal. A sampling of the original rapid responses (after editing) appears below. The complete debate appears at http://bmj.com/cgi/eletters/323/7321/1079.—EDITOR

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Doctors as killers

This article originally appeared in BMJ USA

Editor—Speaking as a non-medical person, I would not wish to be treated by any doctor who is willing to kill patients, even at that patient's request. It should never be a doctor's job to act as executioner for those who no longer wish to continue living or whose life is so "deficient" that it is not considered worth living. All of us will eventually die, some with "dignity," some without, and we have very little choice about this. I cannot imagine anything more undignified than being "put down."

Royal College of Surgeons srynne{at}rcseng.ac.uk

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Moral bankruptcy

Editor—The system we all have legalizes the killing of a three-month-old fetus, which has the potential to be born as a normal healthy child and live maybe 80 years of fruitful life. Yet the same system denies a woman with an incurable debilitating and fatal illness, to die with dignity at a time of her choosing. We are all morally bankrupt.

Cleveland, Queensland, Australia Sri_Varman{at}health.qld.gov.au

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It's my right

Editor—An awful lot of moral and ethical clap-trap is being bandied about. The decision about dying is a personal one: I have no right to influence your decisions and you have no right to interfere with mine. Throughout my life I have freely made my decisions, and reaped the consequences of those decisions. I chose my profession, and strove to achieve my goals. I chose when to take my driving license. I choose what I wear, what I eat, what I do. I chose when to relinquish full-time employment and how to use my leisure. Having spent a lifetime of decision-making, why may I not choose how and when to draw my life to a conclusion?

davidhenshaw{at}cix.co.uk

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Hypothetical moralizations

Editor—The hypothetical moralizations of Professors Doyal have little relevance to end-of-life care in the real world. A patient who is dying and becomes incompetent would not normally be kept alive artificially by medical technology. And if such treatment is in use, to withdraw it is to allow death to occur naturally, not to hasten it.

There is a huge moral difference between allowing a terminally ill patient to die, competent or otherwise, and actively killing them. Legalized voluntary euthanasia for the terminally ill leads to involuntary euthanasia, including those not terminally ill, people with treatable psychological disorders, and those who feel a burden. The Dutch have proved this beyond any doubt.

Austin Repatriation Medical Centre, Melbourne 3084, Australia RogerWoodruff{at}access.net.au

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A physician's duty

Editor—It is the job of physicians to provide excellent end-of-life care, to alleviate pain and suffering amongst the dying and those (temporarily) left behind. It is not the job of physicians to kill people. Killing is not part of caring, just as death is not part of life.

United States david.silverman{at}phoenixwm.com

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Help me end my life if it becomes intolerable

Editor—I am a 70-year-old woman who nursed both a husband and a mother who ended their days in indignity and ill health. I would like to have the reassurance of knowing that, if I reached the state where my life was no longer of value to me, there would be a caring and kindly doctor who would not put his career and reputation on the line in order to help me leave this world with dignity.

When my mother started developing Alzheimer's and understood what was happening, she begged me "to get some tablets so I do not live to be a stupid old woman." She survived for five years—an incontinent, shambling wreck of the strong and intelligent person she had been. My husband, following a physically disabling stroke at the age of 53, repeatedly stated that should he become more disabled, he would not wish to live. Twelve years later having, for seven years, been unable to communicate or understand language, he died in a psychiatric unit exhibiting such bizarre behavior that I could no longer care for him at home.

Others may decide they wish their lives to be sustained in these sorts of circumstances. I know I would rather die with some dignity remaining at a time of my choosing.

dianemunday{at}care4free.net

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