Letter: You can't go your own way

JULIA SINCLAIR has graphically described her father's suffering during his terminal illness ("Why my father had to die", Real Life, 6 December). The fact that, as a society, we have not yet succeeded in affording support and dignity to those in the process of dying is an indictment of us all.

I must take issue, however, with one point. Ms Sinclair states that her father had executed a living will, and that her mother begged the young GP to act on it. She suggests that such action meant administering a possibly lethal dose of morphine to relieve her father's suffering. She asks why anyone should not have the death specified in advance through a living will if they become terminally ill or experience intolerable pain. This identification between living wills and euthanasia was what stalled reform of the law by the previous government. The present government is still reviewing the need for legislation, but there are serious gaps in the law, and situations such as the one described by Ms Sinclair raise difficult legal, as well as moral and emotional questions.

It must be emphasised, however, that living wills (perhaps more accurately referred to as advance directives, or advance refusals) are of limited effect, in that they simply extend the right of any competent patient to refuse medical treatment. No patient has the right to require treatment of any kind; that is always a matter for medical judgement. Leaving aside the question of whether ending or shortening a life can be called "medical treatment", no doctor can be required to do this when compliance is potentially a criminal act. In practice, of course, some treatment does shorten life. In the situation described, the young doctor was put in an unenviable position.

At present, individuals should not assume they can require doctors to end their lives. The choice can be made to forgo aggressive treatment or surgical intervention, so that palliative care only would be the outcome. Beyond that, any doctor must balance his or her compassion against the unlawfulness of an act which is intended to, and will, cut short a life.