Dear Editor

Dr da Costa et al, and Dr Gatrad in his accompanying commentary [Arch Dis Child Fetal Neonatal Ed 2002;86:F115-9], are mistaken in drawing convulsions about Muslim families in relation to ‘do not resuscitate orders’. Gatrad suggests doctors should receive training in ethical issues of other cultures. Firstly, it is impossible to know the religious or historical or personal background of every parent. Secondly, Muslims are not an homogenous group, just as Buddhists or Baptists are not. To assume that because someone has a particular surname (e.g., Singh, a name usually associate with Sikhism) or comes from a particular country (e.g., India, where many people are Hindus) or is of a particular religion (e.g., Catholicism, as there are lapsed Catholics, middle of the road Catholics, and ardent Catholics) that they have a particular set of beliefs is very unwise. Indeed, it is racist. For example, I have an evangelical Christian faith, which is probably different in some respects from many other evangelical Christians. What would my views be on ‘do not resuscitate’ if faced with that for my children? Whatever they are, I would be annoyed if my children’s medical attendants assumed that I had the same views as all evangelical Christians.

Which raises a third point. Why are such issues only considered for ‘ethnic minority’ groups? I have yet to read a paper or hear a presentation on cultural aspects for Methodists, Plymouth Brethren, born again Christians, etc. In the end, though, it doesn’t matter, and neither do da Costa et al’s or Gatrad’s views. It is important to treat the families with respect, and listen to them.

I do not know the situation in Oman, where da Costa works, but in the UK I think the pendulum has swung too far in terms of how we involve parents in ‘end of life’ decisions. The parents’ views are important but not determinative. Society, and the Courts, have devolved those decisions to doctors. To ask parents to be involved in those decisions about their own children is an unfair burden for them to carry, possibly for the rest of their lives.

Dr Charles Essex