From Professor Michael N. Marsh

Sir, - Some issues need to be raised regarding the Revd Professor Robin Gill's remarks about Tony Nicklinson's predicament (Comment, 13 July).

The emotive "massive" applied to his pathology might be directed more usefully towards the disablements resulting. Locked-in syndrome results from localised mid-brainstem (usually pontine) damage, thereby impairing ascending sensory and descending motor long tracts going to and from the cortical areas.

"He is dependent . . .": yet thousands of other patients with brain damage or cerebral degenerations also need their bottoms wiping, urine collected, and dribble wiped away. His wife declared a week ago in The Times that this robs her husband of dignity. But that assertion, in one swipe, denies the very dignity that accrues to all those who are often selflessly and compassionately vouchsafed this needed form of care - now and throughout the centuries - whether in religious houses, hospitals, care homes, or hospices.

An Oxford colleague of mine has a permanent tracheostomy and is fed through a percutaneous gastrotomy tube. I don't think this takes his dignity away. Moreover, he is still intellectually active and alive.

"Modern medicine is increasingly able to prolong life" is, at best, a truism when applied to Mr Nicklinson, and is often employed as a rather uninformed rubber-stamp approach by the media. I have noticed that the media invariably state that all Mr Nicklinson can do "is blink and move his eyes". But note: he can also see, hear, smell, and think: his full intellect allowed him to testify to the recent Demos report on assisted dying.

Whether "modern medicine . . . prolonged [his] life", to quote Canon Gill, is a moot point: surely a respirator and feeding tube could hardly be deemed "high technology". Thank goodness that other forms of advanced technologies permit him, and others like him, to be able to communicate.

To compare Mr Nicklinson with Tony Bland is hardly a useful strategy to clarify these issues: locked-in syndrome and a vegetative state are different conditions. Bland's brain was totally damaged, and his cerebral hemispheres contained a large collection of blood and necrotic neural debris. Bland was virtually dead from the outset, given that his lower brainstem centres were severely compromised. In other words, he was in an extremely terminal vegetative state.

It is preferable not to use the descriptor "permanent", because some of these patients improve and even wake up. But we should be clear that such a possibility requires the continuous dedicated nursing skill, care, and compassion without which those improvements would not be realised nor seen to be possible.

The critical questions for which Canon Gill needs to find answers are: why did Bland and the almost identical Italian case of Eluana Englaro (on a respiratory pump for 17 years) die within three to four days after the pumps were switched off, and, more importantly, what are the control cases (and they are available) by which those deaths could be more sensibly compared and evaluated?

Contrary to Canon Gill, Bland and Mr Nicklinson are by no means comparable cases, as the neurological details given above specifically indicate. A more relevant example would be Professor Stephen Hawking, who, for other reasons, has little residual body function. Yet with eye blinks, computerised techno- logies, and voice synthesiser, Professor Hawking watches the universe, applauds work with the Hadron Collider, and still busies himself with "God-at-the-extremes" cosmology.

We may not have a practical solution for Mr Nicklinson (yet), but he does possess the power to die, and, at his choosing - by refusing all fluid and calories. Why should that be "barbaric", given that it would be his choice? The "discomfort" that he thinks would ensue could be relieved pharmacologically by doctors or family, without contravening existing legislation. Furthermore, why is life so "intolerable" for him, while Professor Hawking just gets on with the job despite similar dysfunctions?

Given the innumerable photographs that have appeared very recently in The Times and elsewhere, Mr Nicklinson appears to be in good shape, despite his undoubted disabilities. Comparatively, he may be better off than many of those other helpless demented souls who know neither the day, time, nor place, and for whose cause there has never been such elegant publicity. So, after seven years, why does Mr Nicklinson still have to be so enraged?

Canon Gill's assessment is neither strictly accurate nor clear, and so, in my view, does not help much in advancing beyond the dilemma of this, or allied, matters. Assisted killing is illegal: judges cannot contravene the law with a wink here and a nudge there.

There is one final point arising that all of us might consider: are people "better off" dead than alive - and why?
MICHAEL N. MARSH
Wolfson College
Oxford OX2 6UD