Any decision on assisted dying should not be made by clinicians alone

sir Jonathan Sumption (Comment, March 29) has, it would seem, made up his formidable mind on the issue of assisted dying. He has decided that, in the case of terminal illness, a medical practitioner would be the appropriate person both to confirm the diagnosis and ascertain whether the patient’s decision to end their life is being made without coercion or undue influence.

However, whereas the first function is purely a medical matter, the second is not. The 1959 and 1983 Mental Health Acts ensured that doctors, including psychiatrists, shared the responsibility of deciding whether a person should be detained against their will. A mental welfare officer or an approved social worker was given the authority, having “interviewed the patient in a suitable manner”, to overrule on social grounds the purely clinical diagnosis.

Those of us who have discharged responsibilities under these Acts know what a conflict there can be between diagnosticians and those required by law to have a primary concern for the autonomy of the patient. GPS used to be trained in interview skills, and were proficient in ascertaining “presenting symptoms” from “underlying” ones. Unfortunately, these skills will be lost now that GPS conduct most of their interviews online or by telephone. However, I strongly believe that any decision to allow assisted dying should be a shared responsibility between clinicians and those with interviewing and counselling skills. Paul Griffith

Caersws, Montgomeryshire

sir – There needs to be a debate on assisted suicide, but it must include dementia. We are quite good at managing pain and the hospice movement is excellent, but what most people are afraid of is the pointless, lingering death of dementia.

In 2011 we had a referendum on proportional representation, but the choice was so limited it was meaningless. A choice on assisted

sir – Reading Lord Sumption’s very clear analysis of the issues surrounding assisted dying, I came to a slightly different conclusion from his. If release from intolerable physical or mental suffering of the terminally ill is to be the justification for it, then surely a requirement should be certification by a designated expert medical panel that their suffering cannot be made tolerable by palliative care. David Cockerham

Bearsted, Kent

sir – From the age of 18 we are responsible for our lives and the outcomes of our actions. However, when it comes to old age we are not deemed able to be responsible for ourselves. Why is this so? Diana Geraghty

Berkeley, Gloucestershire