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Medicine and Public Policy |

The Debate over Physician-Assisted Suicide: Empirical Data and Convergent Views

Timothy E. Quill, MD; Diane E. Meier, MD; Susan D. Block, MD; and J. Andrew Billings, MD
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From The University of Rochester School of Medicine and Dentistry, Rochester, New York; Mount Sinai School of Medicine, New York, New York; and Harvard Medical School, Boston, Massachusetts. Disclaimer: The views expressed here do not necessarily reflect those of the University of Rochester School of Medicine or its Department of Medicine. Acknowledgments: Drs. Billings and Meier are Soros Faculty Scholars of the Open Society Institute. Requests for Reprints: Timothy E. Quill, MD, Department of Medicine, The Genesee Hospital, 224 Alexander Street, Rochester, NY 14607. Current Author Addresses: Dr. Quill: Department of Medicine, The Genesee Hospital, 224 Alexander Street, Rochester, NY 14607.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(7):552-558. doi:10.7326/0003-4819-128-7-199804010-00006
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The debate over physician-assisted suicide is a small part of the process of improving care for all dying patients and their families. Available data, although limited, can help clarify this narrow debate and can provide a useful context for articulation of the common ground. This paper reviews these data, which suggest that unnecessary end-of-life suffering can be considerably reduced by improving access to and delivery of palliative care and improving recognition and treatment of pain and depression in terminally ill persons. It also sets forth possible areas of common ground between the two sides in the debate. Even with the best of care, a small number of dying patients will still have suffering that cannot be satisfactorily relieved, and some of these patients will request assistance in hastening death. Terminal sedation and the voluntary cessation of eating and drinking may be legally acceptable alternatives to physician-assisted suicide for the few patients whose suffering cannot be made tolerable with standard palliative interventions. Physicians should not violate their fundamental values when faced with such patients but should make patients aware of the full range of available alternatives to prolonged, intolerable distress. Physicians have the responsibility to give comprehensive palliative care to terminally ill patients and their families throughout the dying process and to make every effort to explore, understand, and address suffering that persists despite their best efforts.





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