An ethical adviser to the British Medical Association has firmly backed non-voluntary euthanasia for patients who are too ill to ask for death. Professor Len Doyal, an emeritus professor of medical ethics and a member of the BMA's ethics committee, writes in the new Royal Society of Medicine journal Clinical Ethics that dignity in dying sometimes means that doctors should kill their patients.

Debate over euthanasia and assisted suicide has vexed the UK for months. Supporters normally deny that legalisation would shove the country down the slippery slope towards euthanasia of the non- voluntary kind. However, Professor Doyal not only backs non- voluntary euthanasia, but argues that it is "morally wrong" to be silent about it out of political expedience. There has been no disavowal or reaction from the BMA, which last year withdrew its long-standing opposition to legalisation in favour of neutrality.

The crux of Professor Doyal's argument is that withdrawal of life-sustaining treatment like food and water from unconscious patients is morally equivalent to active killing. Hence, to spare patients needless suffering, direct killing is preferable, presumably by a lethal injection. He contends that "regulated, intentional active killing can have a proper place in good medical practice".

Of course, even incompetent patients would not suffer if they had adequate palliative care. But Professor Doyal points out that there is already a shortage of palliative care specialists for competent patients. "What would be the moral point," he asks, "in expending such valuable resources on severely incompetent patients whose best interests will be served by a quick and painless death?"

The co-author of a 2000 book with Professor Doyal, Professor Jeffrey Tobias, of University College London, wrote an indignant letter to the Guardian. "It is exceptionally unusual for life to continue in an extended and distressing way once a medical decision has been made to discontinue support -- a decision always taken with the patient's or family's consent. I would go further and argue that this is precisely the reason why clinicians become so irritated with so-called ethicists like Professor Doyal who, by and large, have no medical qualification and no direct experience of the burdens, challenges and privileges of clinical responsibility, but none the less adopt the moral high ground."