LettersThe BJGP welcomes letters of no more than 400 words,particularly when responding to material we have published.Send them electronically to jhowlett@rcgp.org.uk, andinclude your postal address and job title, or if thats impossible,by post. We cannot publish all the letters we receive, and longones are likely to be cut. Authors should declare competinginterests.

Assisted suicideLast time I wrote about dying at home, itwas my personal view of my grandmotherseuthanasia in Holland.1 I have now beeninvolved in a similar situation, a death fromcancer in Britain and I was notimpressed. This time it was not a relativebut a friend an 88-year-old gentlemanwho died of lung cancer. I am a generalpractitioner in another city. I watched thingsunfold; I wanted to be there for him and notget involved.

I visited him in hospital, walkingassertively onto the ward outside visitinghours. He was discharged on a Friday andtold the Macmillan nurses would contacthim on Monday. He was short of breath atrest, but talking in sentences, mobile, andeating small meals. His pleural effusion hadbeen drained and pleurodesis attempted.He had been a very active man, walkingmiles a day with the dog until 6 weeksbefore admission. At home he lived with his84-year-old wife. The family managed toarrange oxygen and sleeping tablets onFriday afternoon from his GP surgery; hehad been comfortable on these in hospital.They were not supplied with his discharge(there was a note about not supplyingsleeping tablets long term). He deterioratedquickly, became more breathless, stoppedeating, and became bed bound. His wifehad difficulty getting him to the toilet andthis was a problem at night when they werehome alone. The Macmillan nurse arrivedon Wednesday, by which time the familywas angry and had verbally complainedabout this delay. He was put on oramorphas required, and the social worker came thesame day and arranged a night sitter. Thesenice ladies were not nurses and couldcome for 5 nights only. They could notadminister oral medication. They did,however, agree to give morphine if his wifehad drawn it up in advance but did notseem that confident about knowing whento give it. By Thursday, my friend hadcalled out his GP and asked him to end it

all with an injection. Like my grandmother,he was losing his dignity and didnt want togo on anymore. His GP asked him if hewas afraid to die, but with this remark thedoctor missed the point. My friend wantedto die at that time and not suffer anymore.He was prescribed oral diazepam. I toldhim he knew euthanasia was illegal, but Iwould do my utmost to decrease hissuffering. One Saturday I turned up early tofind him breathless, exhausted and indistress. I gave him oramorph anddiazepam (he had not had any since 10oclock the previous night) and he fell intoa peaceful sleep. His wife told me shewished hed sleep like that until he died. Irang the district nurses, and suggested asyringe driver because he was becomingunable to take oral medication and needed24 hour symptom relief. Due to a shortageof diamorphine, a low dose fentanyl patchwas tried. This takes a long time to workand he was to be given oral morphine untilit did work. By Sunday morning he couldbarely take anything orally and again Iasked for a syringe driver. Now there wasdiamorphine. The only problem was thatthe hospice had suggested 10 mgdiamorphine over 24 hours with the patch,and the on call doctor prescribed 20 mg.The district nurse would not give myfriend this dose and it took her 3 morehours to get the right dose. She wasworried about suppressing his respiration,something the relatives by that stagecould not understand. By 2 p.m. thesyringe driver was up and at last my friendwas comfortable. He died peacefully thatnight.

What shocked me was how much I hadto become involved. I wanted to watch himdie peacefully at home with good palliativecare. If you wont allow euthanasia, pleasegive people a good alternative.

F van Veen-ZwartGeneral practitioner, Upwell Street Surgery,Sheffield S4 8ANE-mail: vanveen@tiscali.co.uk

British Journal of General Practice, November 2005 883

REFERENCE1. Zwart F. A very special day. BMJ 1997; 315: 260.

Competing interestsNone.

I am writing in support of the viewsexpressed in the essay by Ilora Finlay inthe September edition of the journal.1 Thearguments against euthanasia andphysician-assisted suicide were wellpresented, and I have felt motivated towrite to my MP about this issue, in timefor the forthcoming Parliamentary debate.

Sandra Gordon8 Springhill Avenue, Crofton, Wakefield WF4 1HAE-mail: ian@igordon.fsnet.co.uk

REFERENCE1. Finlay I. Assisted suicide: is this what we really want?

Br J Gen Pract 2005; 55: 720721.

Congratulations to the RCGP for having thecourage and determination to call for thelaw on euthanasia to remain as it is.

I feel both proud and relieved that one ofthe professional bodies to which I belonghas now stated so clearly its opposition toeuthanasia; and embarrassed and ashamedthat the other (the BMA) has not.

James GerrardMRCGP, Windmill Health Centre, Mill GreenView, Leeds LS14 5JSE-mail: james.gerrard@nhs.net

It is encouraging to find a stand beingtaken against assisted suicide, somethingclearly repugnant to the majority of GPsand elegantly discussed in the article byIlora Finlay.1

Over a long life in general practice I havenever found it impossible to find pain relieffor patients either administered by myself orthe practice nurse, or in one of ourexcellent hospices. Moreover, it alwaysseemed to me that we did our best and ifsometimes death was hastened by ourdrugs, that is surely a common feature of

Letters

MagdalenaHighlight