The question of euthanasia to actively end the suffering of a patient in a terminal condition has lately attracted a great deal of discussion. The Hippocratic Oath is often quoted as sacrosanct, but laymen may not understand what it is all about.

First of all, the original Hippocratic Oath of 5th century BC is no longer used. Although several modern versions have been written, very few medical schools in the world nowadays require their graduates to take any oath. Laws governing the conduct of medical doctors have rendered any oath taking redundant.

The original Hippocratic Oath begins with swearing to a number of Greek gods. The doctor then promises to repay teaching of his teacher by teaching the teacher's son the art of medicine.

He swears to take good care of his patients and avoid administering poison to anyone. He promises not to do operations for stones. He will treat different ranks of his patients equally, and will refrain from acts of an "amorous nature". Finally, he promises to respect the privacy of his patients.

The medical dictum of "first, do no harm" was introduced later.

Active euthanasia, of course, contradicts the original Hippocratic Oath and laws of most countries in the world.

Furthermore, it is unfair to saddle a doctor with the onerous moral responsibility of cutting the last straw of someone's life.

However, there is a difference between an act of commission and an act of omission. When a patient has no hope of recovery and is suffering, the doctor can omit active treatment, such as antibiotics, chemotherapy and undue parenteral nutrition.

Whatever doses of analgesic and sedative drugs required to keep the patient comfortable can be given liberally, and nature will take its course. This form of pragmatic passive euthanasia has long been practised in medical circles and is usually acceptable to informed relatives. Legally, it should also be acceptable.

Ong Siew Chey (Dr)