sirDr Campbell presents proponents of euthanasia with a dilemma.1 Only voluntary euthanasia is permissible; involuntary euthanasia is always impermissible. The question of allowing euthanasia arises most frequently when patients are terminally ill and experiencing great pain. But in these cases, he argues, if patients request euthanasia, their decision “is not freely chosen but is compelled by the pain”.2 It is easy to exaggerate the problem here; patients may have periods when they are pain-free and affirm repeatedly their desire that death (...) be hastened. Putting this aside, however, what should we conclude if euthanasia performed on patients who are suffering greatly is not voluntary?Dr Campbell concludes: “If the request to end one's life is not made freely, then it is doubtful that such requests ought to be followed”.2 An advance directive will not help, we are …. (shrink)

sirPremarital sex is socially and religiously unacceptable in some cultures, with grave consequences such as shame, rejection, divorce, or even death to “cleanse the shame”. Hymenorrhaphy or hymenoplasty has emerged as a procedure which attempts to restore the ability of the hymen to bleed at intercourse on the wedding night, thus protecting women from violent reprisals.A few articles have recently appeared in the English literature debating whether hymenoplasty is clinically indicated or ethically justified.1, 2 If we review the English literature, (...) we find only one article addressing the success of this operation in a group of 20 patients.1 The authors claim that all 20 were satisfied with the outcome and none had regrets. Long term follow up is available on …. (shrink)

sirIn a scholarly and thought-provoking paper, Clarke sets out to debunk the concept of “rational suicide” as nonsensical.1 His motivation in this is to undermine any support that the notion of rational suicide might give to a “categorical right to suicide”. If his enterprise were successful, however, it would go far beyond the “rights issue” and would have a profound impact on all arguments raised in support of euthanasia or physician-assisted suicide.Clarke's major thrust might be termed the argument from posthumous (...) ignorance. He begins with a claim that the process of making a rational decision involves the process of “gaining all possible facts and `imagining' all possible consequences”. He goes on to say that making a rational decision “in the consideration of life or death . . . would seem to be impossible”. It is “impossible” …. (shrink)