A compassionate doctor will do everything to alleviate a dying patient's pain, but as Health Editor Barry Nelson reports, too much kindness can land them in hot water.

FOR thousands of years, newly-qualified physicians all over the world have taken the Hippocratic Oath that promises to uphold the sanctity of human life.

One of the key elements of the pledge is a solemn promise that a doctor will "practise and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them".

Today, improved palliative care makes it possible to prolong the lives of patients who would most certainly have died just a few decades ago, leaving some doctors to openly wonder if what was once an invaluable moral guide is now an outdated relic.

In this country, the General Medical Council provides clear modern guidance in the form of its "Duties of A Doctor" document which says: "Patients must be able to trust doctors with their lives and well-being.

"To justify that trust, we as a profession have a duty to maintain a good standard of practice and care, and to show respect for human life."

But doctors armed with pain-killing drugs and life support technology can still find themselves facing a terrible dilemma: can too many drugs really be a case of killing with kindness?

Professor Tim van Swanenberg, professor of postgraduate general practice at Newcastle University Medical School, says palliative care for the dying is one of the main topics covered in the training of GPs.

"Typically, our trainee GPs will study what we call 'significant events' - real cases which our GP trainers will have seen. They discuss the ethical issues raised by each patient," he said.

Prof van Swanenberg strongly supports the line taken by the Royal College of General Practitioners, that assisted dying or euthanasia is not something GPs should engage in. "It is all about intent. The intent of GPs is to care for their patients," he says.

"Administering diamorphine in the last stages of a terminal illness is done with the intent to relieve pain, not to hasten death.

"Assisted dying is quite different because it suggests the intention is to hasten the end."

The professor says his own personal view is that the law, which prohibits assisted dying, should stay where it is.

"Those who believe in assisted dying have not considered the impact on the doctors themselves and their future patients," he says.

"What might elderly patients think if it doctors were allowed to hasten death? I think it would create great difficulties and undermine the relationship of trust between patient and doctor."

He continued: "It is a completely different way of practising. We are used to what we do now. I don't see any reason to change it."

One North-East GP, who has worked in the region for a number of years, admitted: "People do ask if we can help them. They say 'I don't want to suffer...don't let me suffer'. The answer has to be, I am not allowed to."

But compassionate GPs do all they can to provide relief to those who are facing intolerable pain because of cancer or another terminal condition.

The GP said: "With pain control, you need a dose to get the patient over the pain. Once you have got them over this barrier, they become less anxious and settle down."

Most family doctors now work as a team and have guidelines in place for dealing with terminally ill patients who need treatment at home.

"You usually have two GPs involved and meetings rather like a case conference to discuss treatment," said the GP.

"It is partially to protect yourself and partially to share management of the patient. These days, you don't need to do things on your own."

Ultimately, the decision about the amount of pain-killing drug a patient needs is up to the individual doctor on the scene.

Crucially, to stay within the law, the intent when administering drugs such as diamorphone must be to ease pain rather than hasten a patient's death.

"It is an area we all have problems with. We all run the risk of ending up in court," the GP added.

In March, Lord Joffe is expected to put forward a bill proposing a lifting of the UK right to die ban to "enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his/her own considered and persistent request."

It is understood that Lord Joffe has altered elements of his Bill to make it more acceptable to the Government after an earlier version ran out of parliamentary time.

It will be interesting to see whether the Government is willing to allocate precious legislative time that might allow the Bill to become law.