I write to present a perspective different to that expressed by Dr Rachel Clarke (I can truly see the case for assisted dying. But the horrific state of the NHS makes me question if it is the best idea, 1 May). A form of assisted dying happens every day in hospitals, particularly in intensive care, where I spent 24 years. This form of dying comprises the withdrawal of active support, drugs and machines in patients whose further treatment is deemed futile. These patients are invariably incompetent to give consent by virtue of an impaired level of consciousness, caused by their illness and drugs. This decision is made by doctors and is legal. It is always discussed in detail with the patient’s family, but the decision is not theirs to make. In law, only an individual can give consent. If they are not deemed competent to give consent, responsibility passes to doctors, who are legally directed to act in the patient’s best interests. The process is carried out with kindness and compassion, minimising distress for both patient and family. All drugs are stopped. Sedation is maintained and artificial ventilation with room air, not oxygen, is continued. Is there a moral and ethical difference between stopping treatment that would otherwise prolong life (an act of omission), and giving drugs that would ensure a distress-free and dignified demise (an act of commission)? And why should it fall to doctors to make this invidious choice? Dr Jagat Aulakh Retired director of intensive care and consultant anaesthetist, Southam, Warwickshire