Sir: The case of Dr Nigel Cox will inevitably increase the demands to legalise voluntary euthanasia. As you rightly point out (leading article, 21 September), the case against such a move is a powerful one. Nevertheless, doctors have a duty not only to protect patients' natural right to live but also their natural right to die.

Where the outlook is hopeless, high technology and life-prolonging treatment are inappropriate. Care has then to be directed to the relief of pain and distress and the support not only of the patient but also of those close to him or her. However, such care often requires the advice and help of those who are experts in palliative medicine. Was such care and expertise available to Mrs Boyes and her family?

It is a simple fact that pain control and palliative medicine services are a low priority for many health authorities. Pain clinics are under threat of closure in some parts of the country. Hospices are to a very large extent funded from voluntary sources. Thus the number and type of patients they can care for are limited.

The issue is not whether voluntary euthanasia should be legalised, but whether there are adequate services for the proper care of the terminally ill within or in conjunction with the NHS. The evidence is that there are not.

Yours faithfully,

JOHN SEARLE

Consultant Anaesthetist and Chairman

The Exeter and District Hospice

Exeter

21 September