Sir.—I read the editorial by Boyce1 in the August 1990 issue of AJDC and believe it discusses a subject that should be of great interest to everyone. Dr Boyce is a thoughtful and kind individual who has given the reader his "highly personal" view on this subject. While personal views are sometimes insightful and creative, they may also fail to note that there may be extensive literature on the subject.
Twenty-five years ago, I began what has evolved into an annual lecture to freshmen medical students at Jefferson Medical College, Philadelphia, Pa, entitled "Medicine, An Excuse From Living."2 It was published in 1978 and reprinted in 1990.3 Before and since the 1978 publication, many articles have been published dealing with this subject. The publications are not all in agreement and they do not reflect the same level of scholarship or insight.
Dr Boyce discusses five criteria