• K Andrews.
• Research Services, Royal Hospital for Neuro-disability, West Hill Putney, London, UK.
• Br. Med. Bull. 1996 Apr 1; 52 (2): 280288280-8.

AbstractOne of the major dilemmas for the clinician caring for people with chronic disabling conditions is how to provide not only a good quality of life but also the best quality of dying. It is my view that the clinician should provide the opportunity for living before giving the opportunity to die. By this I mean that the clinician has the responsibility to ensure that efforts have been made to improve the quality of life by controlling clinical situations and providing psychological and emotional support. Once the decision has been made by patient, family and clinical team that it is inappropriate that life should continue, then the quality of the dying process should be of the highest standard. The present attitude of ending the patient's life by withdrawal of nutrition and fluids is highly unsatisfactory, if not inhumane, and the option of euthanasia would be by far a more satisfactory solution. In addition, a more satisfactory procedure than application to the High Court for a directive on withdrawal of tube feeding needs to be found. This method is very stressful for family and staff already in distress and is an extremely expensive approach. An independent ethical panel to ensure that the decision to end the patient's life is clinically appropriate, is being carried out purely for the best interests of the patient and is not influenced by the other considerations.

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