Letter: Euthanasia: definitions, the Dutch example, dignity, and a judge's words

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Sir: I wish to disagree with the statement by Ian MacKinnon (report, 21 September) that 'no one disputes that euthanasia is practised by doctors in Britain's hospitals every day'. I dispute it, and am sure that I am not alone in this.

Most definitions of euthanasia include the concept of deliberate death acceleration, usually by the administration of a drug with the specific intent of ending a patient's life. This is clearly distinct from relieving 'the suffering of incurably ill patients . . . even to the point where it shortens life' - a situation in which the doctor is using painkillers and/or sedative drugs to relieve symptoms while, at the same time, accepting that such measures carry the risk (but not the certainty) of bringing forward the death by a few hours or days of someone who is already close to death.

To confuse these two actions (as Ian MacKinnon appears to) serves only to confuse the whole euthanasia debate. For example, it leads to misplaced demands for legislation - to regularise what doctors are supposed to be doing already. In Oxford, a light-hearted parallel may be drawn from the fashion for stealing bicycles and cars: 'No one disputes that theft of bicycles and cars is practised by citizens in Oxford every day.' Yet to draw the conclusion that such theft should be legalised is a non sequitur.

The danger of acquiescence in euthanasia (as in the Netherlands), or in actual legislation, is that of abuse. In the Netherlands, the government acknowledges that some doctors already practise deliberate death acceleration without the patient's explicit consent. This acknowledgement confirms what many fear, namely, the slippery slope from voluntary to involuntary.

The only safe way forward is to maintain the present status quo in which, provided all other avenues have been explored, the doctor has the liberty on the grounds of necessity (force majeure) to administer heavy sedation to keep a patient asleep until death occurs. Such an approach relieves suffering without crossing the Rubicon - the point of no return - and breaking the general principle of the sanctity of life. It may seem a fine point, but it is, I believe, a crucial one if the elderly, infirm and dying are to remain confident that their doctor is not going to end their lives against their wishes.

Yours sincerely,



22 September

The writer is Clinical Reader in Palliative Medicine at the University of Oxford.