Doctors in support of law reform for voluntary euthanasia

TO THE EDITOR: The perspective of the Doctors for Voluntary Euthanasia Choice needs to be challenged.1 Firstly, irrespective of one’s views on the matter, it does not seem reasonable for euthanasia to be legalised so that doctors can avoid the scrutiny of the law. Secondly, the authors point out that “pain may not be a prominent symptom, making death by morphine legally unjustifiable”, therefore implying that morphine has a “double effect” of sedation and hastening death. The claim that morphine h s efficacy in causing death is erroneous. The principle of “double effect” was first expounded in a trial in 1957, where prosecution and defence expert witnesses differed as to the excess or otherwise of the amount of opioids delivered by a doctor in unrecorded doses to a patient.2 The prevailing medical view then was that morphine in high enough doses caused respiratory depression and consequent death, implying that morphine influences its timing and causation. However, experience over the past 5 decades has shown that the safe and effective use of morphine, other analgesics and sedatives relieves pain and distress but does not cause death.3 This is because tolerance to respiratory depression occurs fairly rapidly with regular consistent use, and underlying pain antagonises respiratory and sedative effects.4 But opioids, like any drug, if used inappropriately, will be dangerous. Therefore the use of the “double effect” defence is not possible. Regardless of whether one supports euthanasia or not, doctors’ actions should be subject to scrutiny to protect the public and their own moral and ethical standards. “Get out of jail free cards” should not be allowed to justify bad medicine.