We are a group of doctors involved in the care of terminally ill patients, and we refer to the letter by Allison Yeung entitled 'Let patients choose' (South China Morning Post, January 26).
The author shared her painful experience while she accompanied her grandfather through his last journey. We feel sorry in knowing that her grandfather suffered severe pain before his death, which understandably was a traumatic and agonising experience. We deeply empathise with the family's suffering.
As experienced health carers for the terminally ill, we would like to respond to this letter:
'Not to use extraordinary means to save them' and 'to supply the drugs to kill the patients' are two totally different concepts, with different legal and ethical connotations. The former means 'forgoing futile life-sustaining treatment', whereas the latter means 'euthanasia' as defined by direct intentional killing. As patients reach the end of their lives, the primary emphasis of care is to maintain their quality of life and alleviate symptoms of their illnesses. Therefore, forgoing futile treatment for terminally ill patients is often medically and ethically appropriate and acceptable, whereas 'the direct intentional killing of patients by drug' - or euthanasia - is illegal in most parts of the world and ethically unacceptable.
The author suggested that 'withholding of extraordinary treatment should be acceptable for those patients who have signed a declaration'. In fact, for any mentally competent patients who express a wish to forgo treatment, it is our usual practice to respect that wish.
The author said her grandfather could have had 'a more dignified end had the ending come earlier than it did'. We fully agree that a dignified death is one of the most important goals in end-of-life care. We will not prolong the dying process by extraordinary means, but neither do we agree to terminating life prematurely by euthanasia. With good symptom control, patients can remain in peace and comfort in the last days. In fact, the last part of one's journey can be quite productive and may be the most valuable part of one's life, especially if physical, psychological and spiritual distresses are addressed.
