There is a growing debate among medical and nursing staff about the morality of keeping technology-dependent children alive and whether they actually have any quality of life. This debate will gather impetus as more children are sustained only by means of medical technology. An increasing number of babies born prematurely at 23 weeks (or less) that might otherwise have lived for only a few hours can now be kept alive and may survive into a "normal" childhood. The problem with this group is that one cannot always predict to what degree they will be disabled, if at all, and how dependent they will become.
Having once made a conscious decision to keep a child with complex health needs alive, at what point along their life course can that decision be reversed? As a paediatric nurse who has cared for children like MB, I know of the value that parents place on the lives of such children; for them, their child is every bit as precious and valuable as a so-called normal child.
My professional experience has also taught me that many of those children, even if profoundly disabled and dependent on technology and 24-hour care, have a lot to give and that they enjoy a reasonable quality of life with in the bounds of their conditions. A question is raised about where the greater morality may rest; in preserving life and keeping children alive whatever the cost, or in administering drugs that bring life to a close.
I am pleased for Mr Hari that he sees the issue in such black and white terms and I hope that he is never placed in the position of having to make such a life-or-death decision; it is not one that I would want to make. I do not necessarily agree with his views, but I do believe he is right to raise the debate, because this is an ethical dilemma with which we will be confronted more and more frequently in the future.
GRAHAM LEACH
ILFORD, ESSEX
Nuclear is risky like all power sources
Sir: Twice in a week, The Independent has had a rather scary and worrying front page with an anti-nuclear energy bias: a radiation symbol to announce a report by one particular set of government advisors reiterating their opposition (7 March); and a picture of some sheep still experiencing marginal effects of radiation from Chernobyl 20 years after the accident (14 March). Are they helpful to informed debate?
Generating electricity by nuclear or any means has a risk. Last summer the UN updated its estimate of the Chernobyl toll: 31 direct deaths and 4,200 whose life-span has been shortened. The other two nuclear accidents with potential for public harm the Windscale fire in 1957 and Three Mile Island in 1979 had no direct deaths and no indirect ones that have yet been identified. Over 50 years nuclear power may have killed not more than 5,000 people.
Coal generation is worse, mostly because of long-term lung damage rather than mine collapses and floods. Oil and gas are not much better, because exploration and production are mostly in places which are geographically, climatically or politically dangerous. The worst fatality record of all generators is hydroelectric. Dam collapses have led to some estimates of more than 200,000 deaths.
So, half a century of electricity generation may have caused the deaths of up to 300,000 people. Every one is a tragedy but, to put it in context, a WHO report in 1998 estimated that 100,000 people are killed each month in road traffic accidents across the globe. The International Red Cross has estimated that 250,000 a month die in the developing world because of a lack of clean water.
Which of these should we really be worrying about?
ALAN SHAMP
BATH
Sir: It is heartening to see your paper highlighting the issue that so many of us want to turn a blind eye to. As I read your headline "Poison legacy" (14 March), which was only one among many vital issues to which you have drawn attention recently, I could not help thinking of Edmund Burke's response to Rousseau's social contract: "Society is indeed about a social contract but it is a contract between the living, the dead and those not yet born."
JOHN COLEMAN
LONDON SW8
England needs no parliament
Sir: Mary Dejevsky is wrong ("Why we need an English parliament", 14 March). There is no need for an English parliament because there is no England.
Scotland, Wales and Ireland are fairly homogeneous nations, each with its own clearly defined character and culture. That is why devolution (or independence) has been quite successful in all three. In England, the picture is far more complex. There are millions of Scots, Welsh and Irish living in England. The overwhelming majority of non-white migrants also live in England, along with many hundreds of thousands of other Europeans and people from other parts of the world. England is the genuine mongrel nation, and I welcome that. This fact however, makes identity far more complex and difficult than in the other British nations.
For example, I regard myself first and foremost as a Northumbrian, then as British, and finally as European. Here in the north-east we only began to be part of the nation after 1603. Before that, the independent kingdoms of England and Scotland played havoc with the area, and used it (and abused us) for their own dynastic ends. I have no loyalty to England. For me, the British state has meaning and relevance precisely because it has little connection with a brutal past based on ignorance and exploitation.
The answer to the West Lothian question is the creation of a fully federal United Kingdom, based on Scotland, Wales, Northern Ireland and the regions of England. There would still be disparities of size, but these would be far less than a separate English parliament would create. The failure of the referendum in the North-east in 2004 doesn't invalidate the concept. Devolution is working in Scotland and Wales; and independence has given most of Ireland a new lease of life. We just need to expand that successful formula to the rest of the United Kingdom.
PETER ARNOLD
NEWCASTLE UPON TYNE
Don't scapegoat immigrant doctors
Sir: Julia Doherty (letter, 14 March) is obviously not "too embarrassed or afraid of seeming racist" when she airs her views about doctors from overseas.
It is very unfortunate that a tactless doctor caused her mother so much distress. Of course it is important that anyone who deals with people should tune in to their linguistic and cultural nuances as much as possible. However, the vast majority of "foreign" doctors undergo rigorous often patronising training in local idiom and etiquette. A look at the Professional and Linguistic Assessment Board exam and the GP training scheme will confirm this.
She could also broaden her research and meet the elderly people who appreciate the respectful attitude of doctors from more traditional cultures. Does Ms Doherty object equally vehemently to South African, Dutch and German consultants?
As for the education system, many Indian teachers are unwilling to work here because they think there is not enough respect for education in this country. We need to look at our problems in all their complexity scapegoating immigrants is not the best way to solve them.
SARASWATI NARAYAN
KNARESBOROUGH, NORTH YORKSHIRE
Mythic winger and man of courage
Sir: To Philip Hensher's mean-minded complaint (15 March) on media reporting of the death of Celtic footballer Jimmy Johnstone that "it is difficult to see that most footballers deserve such lavish outpourings of grief", it can be confidently replied that "most footballers" get no such treatment.
That Johnstone did so was for two reasons. As a footballer he was a winger of remarkable and almost mythic ability whose name, in the words of The Independent's obituary (14 March), "echoed around Europe". And, as a human being, his courage, humour and help to fellow-sufferers of motor neurone disease won the admiration of many who had never seen him play.
The fact that Hensher "had never heard of him" is a matter for some reproach rather than for lofty self-congratulation.
DANIEL BAIRD
GLASGOW
The dishwasher, symbol of laziness
Sir: I wash up once a day for a family of three. I only ever use one bowl of water, my pots are always clean, none of us have ever gone down with food poisoning.
I can't understand why anybody would think a dishwasher is essential for a household of four or less (letter, 14 March). It's sheer wastefulness and laziness. My parents regularly washed up for a family of six. It wasn't until one particular post-Christmas dinner pile-up of dirty pots that they eventually caved in and bought a dishwasher. And as soon as we kids had grown up and left home, the dishwasher was consigned to the scrapheap.
A dishwasher is a symbol of present-day laziness induced by technology and scientific scaremongering. If the good old-fashioned way was good enough for our parents, it should be good enough for us.
T J HONEYBONE
DONCASTER, SOUTH YORKSHIRE
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