in alleviating the final agonies of patients, when cure has become an abandoned hope and symptoms have overwhelmed palliation, a caring doctor can berate the legal system’s impotence and governmental procrastination in facing the management and termination of intolerable situations. The distinction between permanent relief of pain and misery and the curtailment of a useful life has generated a maelstrom of religious and secular opinions usually replacing meaningful experience. Oncologists of all types are frequently confronted by situations involving the end of a painful existence. Most of them are now assisted by specialists in palliative care, often disempowered by shortages of beds and frustrated by staff inadequately trained or less than sympathetic to the views of those who would like to see “physician-assisted dying” as an alternative to only partially effective, cerebrally numbing analgesia. Cancer, of course, is not the only cause of a prolonged and tormented end to life. Some of the most distressing cases are associated with the neurological prisons that mean a fully conscious person is cut off from mobility, self-care, sensory input and communication.

In a deeply personal, well researched and detailed book, Rodney Syme has set forth the case for accepting the inevitable and releasing a human being from a useless and burdensome existence. He relates his own experiences that, over 30 years, have honed his ideas of how best to achieve the relief requested by the sufferer. Conditions that have to be met include a clear, unequivocal request to die by the patient. This is extremely difficult where communication has become impossible, and points to the need for a “living will” assigning that responsibility to a nominated person. Nevertheless, euthanasia on demand is not his aim. Rationality is paramount, and the physician’s responsibility in the decision process and its proper administration are theirs alone. The need for a second confirmatory opinion is, unfortunately, not fully discussed.

Syme lays emphasis on the need to allow relatives or close associates the opportunity to say farewell and discusses the reasons for recommending the methods he does. He makes it clear why he has never adopted the execution-style injections of sedatives, analgesics and cardio-respiratory paralytics adopted in other countries. Removal of feeding and hydration by artificial means has to be associated with relieving the additional discomforts of mouth drying, but that was not recognised in the initial stages of end-of-life decisions.

He is incensed by the lack of response to his efforts to bring the issues to the fore through coronial reporting of deaths requiring investigation. His review of the literature is extensive and approving of the opinions of Michael Ashby, Peter Singer, Helga Kuhse and Nathan Cherny. On the other hand, palliative care that dogmatically forbids voluntary euthanasia comes in for a serve, especially where inconsistencies are revealed.

Although this is scarcely a textbook of suicidal methods or a scientific treatise, it is a valuable addition to the discussion of the subject and worthy of reading by those who have to think about such situations. It may help medical practitioners to know that others have had to go through the same convolutions of conscience, and be of comfort to family members to follow the thoughts of a clearly caring doctor.