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All right, so legalising assisted suicide is seriously problematic, but so is the plight of those who now live and die in distress. If we refuse them the right to assistance in killing themselves or to be killed upon request, what alternative solutions are available? Insofar as the problem is the fear of being kept alive in intolerable circumstances, current law does not oblige patients to strive to stay alive at all costs and it already grants them a right to refuse treatment that doctors must respect. This should not be read as sanctioning suicide. It merely recognises that some may reasonably prefer to conserve their limited energies for the process of dying rather than expend them in straining to stay alive.

It is true that some doctors are overzealous in striving to "save" their patients, which implies a need to reform medical education. Doctors need to be educated to see their proper role as including helping patients to die well, and not simply as fending off death. Certainly, that should involve their being made far more aware of the considerable resources of palliative medicine and care. But it also requires more than technical training.

It requires a spiritual formation in which doctors are made into the kind of people who, when faced with death in the eyes of the dying, have the moral strength to resist the natural instinct of mortal human beings, and not to turn away.

The provision of palliative care in Britain is still very patchy. The availability of in-patient palliative care beds, for example, varies dramatically from region to region-and not because of varying levels of demand. If we really care to improve the conditions under which most people die, then there remains plenty of scope for investing more energy and money in building more hospices, multiplying specialist palliative care teams, and integrating palliative expertise more thoroughly and universally into the healthcare system.

But what about that small minority of patients whose suffering cannot be managed by normal palliative means? In those rare cases recourse can be had to palliative sedation, which renders patients unconscious. Sometimes doctors fight shy of this, because they fear killing the patient. Given the contemporary sophistication of drug-management, this fear is very largely misplaced. Nevertheless, were sedation to hasten a patient's death, it would raise no moral or legal objection so long as it had been proportioned to the relief of distress.

Together these measures would go a long way towards reducing patients' suffering. But they comprise no perfect solution. They offer no answer to the frustration of a Daniel James or the prospective loneliness of an Edward Downes. Nor do they offer an end to the sufferings of the grievously bereaved, the chronically depressed, the long-term unemployed or the wretchedly poor. Nor do they offer relief to those sentenced to spend the rest of their lives behind prison walls — at least one of whom, according to his personal correspondence, would jump at the chance of assisted suicide, were it on offer. Compassion obliges us to do what we can and what we may to relieve human suffering. But there are some things that we could do, which we shouldn't — because they create more problems than they solve or because they jeopardise more people than they relieve. Prudence obliges us no less than pity.

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