In facing the management and termination of intolerable situations, a caring doctor involved in alleviating the final agonies of patients can berate the legal system’s impotence and governmental procrastination. Oncologists are frequently confronted by situations involving the end of a painful existence. Most 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 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 relates his own experiences which, 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 when 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, as is the physician’s responsibility in the decision process.

Syme lays emphasis on the need to allow relatives and/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.

Although this is scarcely a textbook of suicidal methods or a scientific treatise, it is a valuable addition to the discussion of the subject. 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.