Sir, Your report “Doctors ‘hasten one third of deaths by using pain relief’ ”, based on a study on euthanasia by Professor Clive Seale of Brunel University (Jan 18), gave a misleading and worrying picture of what this excellent and important piece of research uncovers.

In fact, what the study found was that deaths which might be attributed to euthanasia on the part of doctors are extremely rare (0.16 per cent in the case of voluntary euthanasia) and that such instances are less common in the UK than in the other countries that have undertaken this study.

The “double effect” principle needs clarification. Double effect is where doctors give drugs to a dying patient to relieve distressing symptoms and severe pain, in the knowledge that in doing so they may risk accelerating the dying process. However, there is no evidence that pain-control drugs, when used according to good practice guidelines, do in fact hasten or cause death.

A study published in The Lancet in 2000 found that their appropriate use does not shorten life and argued that the doctrine of double effect must be distinguished from euthanasia “and its role should not be exaggerated”. The law is very clear that the intention of any intervention on the part of the doctor must never be to end the patient’s life, but to relieve their suffering.

While there is much more to be done to ensure that palliative care is available to all at the end of life, the study suggests that palliative care principles — care which aims neither to hasten death nor prolong life at any cost, but which puts at its centre the comfort, wishes and wellbeing of the patient — are what drive the majority of doctors’ actions. This has been the cornerstone of the hospice movement since it began and an encouraging finding to build on. It is also interesting to note that the study found more than 97 per cent of doctors were against a change in the law.

DAVID PRAILL
Chief Executive, Help the Hospices
London WC1

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