“Right to die”

Editor—Grayling claims that the “right to life” means quite a rich life; withholding treatment with death as the result and giving treatment that causes death are indistinguishable; and death is the ultimate analgesic.¹ Grayling also implies that the double effect is widely abused.

The EC Convention for the Protection of Human Rights and Fundamental Freedoms protects against intentional deprivation of life.² Quality of life is not mentioned, and terminating a life at a person's request is clearly not permitted. “Right to life” is perhaps a “right not to be killed,” in medicine, generally relating to survival and not assisted death. However, some interpret it as giving patients a right to cardiopulmonary resuscitation regardless of the clinical circumstances³; extrapolation to all potential interventions at the life-death interface could have disastrous consequences for the medical profession.

Patients obviously can wish for their life to be terminated without needing to explain why, and they arguably have a right to attempt suicide. However, a right to assisted dying equates to a right that somebody else will kill or help to kill them on request—very different from withholding treatment or the double effect.

Withholding treatment relates to interventions unable to produce the desired benefit.⁴ In palliative care withholding treatment does not directly cause death that arises from an irreversible and unsustainable pathological burden. And death without adequate analgesia is possibly the ultimate pain for everyone. Judicious use of analgesia is an essential part of good terminal care, and, in 15 years as a doctor, I have yet to see a death attributable to deliberate analgesic overdose by a doctor.

Palliative care affirms life until the moment of death, regarding death from advanced incurable disease as a natural process.⁵ It aims to relieve pain and other distressing symptoms, enhance remaining quality of life, and neither hasten nor postpone death. These human “death rights” should perhaps be protected by legislation. Ill-conceived legislative changes that take the right to life or the right to death beyond sensible limits or give certain doctors the right to kill on request could jeopardise palliative care.