Sir, I was saddened by the outcome of the Leslie Burke case (letters, August 3 and 7, and September 3) and the implication that doctors could be forced to give treatment against their clinical judgment when patients have validly signed positive advance directives insisting on the provision of artificial nutrition and hydration, no matter how bad their medical condition.

Although most clients I see want to make sure doctors do not “strive officiously” to keep them alive, the ruling undermines doctors and their knowledge and experience.

It was a relief therefore to read the judge’s decision in the case of Charlotte Wyatt. I cannot imagine anything more painful for doctors than having to inflict more pain and suffering on a tiny creature whom they have kept alive because of advances in medical treatment which they could not selectively ignore.

Dr Robert Leeming’s letter (October 8) confirms me in the belief that we need to debate how far we should strive to keep extremely premature babies alive.

Yours faithfully,
LIZ HOLDSWORTH,
(Member, Solicitors for the Elderly),
Yew Tree Cottage,
Longnor, Shrewsbury SY5 7PP.
lizaholdsworth@hotmail.com
October 8.

From Dr Topun Austin

Sir, Most extremely preterm babies grow into normal healthy children.

The newborn brain has a remarkable capacity to recover from injury, making it difficult for doctors to prognosticate accurately at the start of life.

Over the past 20 years there has been a dramatic improvement in survival of extremely preterm infants, although there has been no significant increase in the incidence of severe disability in the survivors, suggesting that modern intensive care is better equipped to minimise handicap in these vulnerable infants.

The debate should focus away from birth weights and gestational ages and on to ways of developing new methods to diagnose and treat infants at risk of brain damage after birth.

Yours faithfully,
TOPUN AUSTIN,
(Specialist registrar in neonatology),
Holly Cottage,
Whitegates Close,
Croxley Green, Rickmansworth,
Hertfordshire WD3 3JY.
topunaustin@doctors.org.uk
October 8.

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