Ethical Choices After a Nuclear Attack

To the Editor. —  In wondering whether our report entitled Selection of Casualties for Treatment After Nuclear Attack was a spoof or a serious exercise in planning, Dr Cassel¹ neglects a third and correct possibility. The report's intention was to stimulate debate by presenting an accurate but provocative account of the ethical choices that would face survivors after a nuclear attack.As the preface states, the public health authorities in the United Kingdom had failed to confront the realities of nuclear attack, but have drawn up civil defense plans that broadly regard it as an extension of conventional war. The British Medical Association's annual meeting therefore asked the association to open a public debate on the ethical issues that would face surviving health workers after a nuclear attack.If Selection of Casualties offends against deeply held ethical sensibilities, perhaps that is because it describes the unthinkable truth about the