Mr Francis Cheng has succinctly summarised some of the salient features of assisted suicide and euthanasia ("Assisted suicide does not violate Hippocratic Oath"; yesterday).

Both assisted suicide and euthanasia are illegal in Singapore, but helping patients in the throes of insufferable pain when illness is terminal is not only not prohibited, but also the only humane way doctors have been trained.

This entails withdrawing treatment which is physically demanding and extremely trying on the patient; the adoption of a philosophy of masterly inactivity, leaving the disease to ravage the unsalvageably sick body unimpeded; and the judicious use of sedation and analgesia to alleviate all pain till the inevitable happens.

It is easy to empathise with family and friends in their desire to keep their loved ones with them as long as possible, hoping that the human will to fight impending death will somehow pull off the somewhat impossible.

But I have never seen miracles happening where diagnoses have been established beyond a doubt, with the patients wasting away inexorably and all clinical parameters pointing to an inevitable painful demise.

When death is the outcome and not the solution, doctors only seek to make this outcome more reconcilable to all concerned by alleviating the intractable pain of the terminally ill.

Close caregivers always intimate how relieved and gratified they are that the end for their loved ones, being painless and peaceful, provided a calming resolution for what is always a period of great angst, grief and depression during the preceding illness.

Yet, patients' will to fight and caregivers' intense desire for a continued medical crusade against even imminent death are always given top priority. The medical profession never promotes death as a culture and doctors never give up till all other parties have.

All death is unnatural and caused by disease and pathology, for which we either suffer intensely but momentarily, or intensely and seemingly interminably.

The least doctors can do when the fight has long been lost is to balance out the equation.

Yik Keng Yeong (Dr)