BOB Scott (Agenda,The Herald, August 13) welcomes yet another attempt to establish physician-assisted suicide to the statute books.

He argues that many GPs are intimidated by the change in culture following the Shipman affair and as a consequence, their ability to deal compassionately with end-of-life care is compromised.

In addition to this, not mentioned by your correspondent, is the untimely demise of the Liverpool Care Pathway, which, in the hands of experienced physicians, has been an invaluable tool in the management of people suffering from terminal illness for several years, and was one of the principal subjects in the MA Ethics of Cancer and Palliative Care course at Keele University, much of the teaching taking place at the Marie Curie Hospice in Liverpool. It is clear that it has not been applied as intended by the authors, in that it has been the subject of spurious targets, and has been initiated by junior doctors without discussion with senior staff and without discussion with patients and their close relatives.

Moving from what was highly effective general practitioner care as a consequence of a change in culture and abandoning the Liverpool Care Pathway because of its misuse should not be regarded as a rational response to these pressures. The role of the general practitioner in community-based palliative care should be strengthened and supported, with the attendant ability to prescribe suitable drugs in appropriate doses to relieve symptoms as necessary, and the principles of the Liverpool Care Pathway must not be lost. Neither of these problems should be used as justification for the introduction of physician-assisted suicide. Counter-intuitively, looking back at the way care should have been provided using the tools available is better than the "enlightened response" outlined by Dr Scott.

Dr Richard Lenton,

Fellow of the Royal College of Physicians and Surgeons of Glasgow and Fellow of the Royal College of Physicians of Edinburgh,

47 Carseview, Bannockburn, Stirling.