Proper palliative care should reduce requests for euthanasia and physician-assisted suicide

Abstract

Dr. Foley's presentation is eloquent and particu­ larly timely. As seen by last November's elec­ tion results, including a referendum legalizing physician-assisted suicide in Oreqon,' the pub­ lic is deeply split regarding this issue. We agree whole­ heartedly with her central message, namely that improved physician-patient communication, respect for patient-centered care, better physician judgment to with­ draw or withhold care and familiarity with the principles and practices of palliative care would definitely reduce the need to legalize physician-assisted suicide and euthanasia:' Dr. Foley emphasizes the theme that no patient should wish for euthanasia because of inadequate treatment of pain. It is a primary responsibility of physicians and other caregivers to ensure that patients do not request to die because of unrelieved paln. Excessive emphasis on euthanasia in many cases has distracted patients and health providers from the manageable task of providing optimal management of pain and other symptoms. Dr. Foley reviews the experience in the Netherlands and points out the dangers of a slippery slope inherent in legalization of euthanasia.':' Certain aspects of the expe­ rience in the Netherlands reinforce this concern. One sur­ vey reported that approximately two thirds of nursing home residents in Holland were afraid that their doctors may one day kill them. Involuntary euthanasia has not been rare, and has been applied both to the elderly and to