[Interdisciplinary discussion about euthanasia--viewpoint of the clinical physicians]

In western cities more than 80% of deaths occur in the hospital. Thus, we should be familiar with the professional care for dying patients. However, reports of euthanasia in the Netherlands and interviews of patients in other countries demonstrate that medical care for patients with end stage diseases frequently is insufficient. The need for palliative care, which encloses medical, psychological, social and spiritual aspects of the dying becomes apparent. The physical symptoms (e.g. pain) are only one aspect of the suffering of the terminally ill. Following the WHO guidelines for use of analgesic drugs pain control is achieved in the majority of patients. Palliative care may individually tailor the treatment and care to achieve symptom control. Legalization of euthanasia will diminish the interest in practicing palliative care and may also limit the enthusiasm in research in this field as seen in the Netherlands. Data analysis report significant increase of physician-assisted suicide and euthanasia in the Netherlands within five years time from 1990 to 1995 (total: 3.7% to 4.7%, euthanasia: 1.7% to 2.4%). In addition, each year about 1000 patients were not competent at the time euthanasia was performed (euthanasia without request)! Furthermore, a patients illness did not have to be in end stage when he required euthanasia. This information should rise concern about future developments! The public enthusiasm for legalization of euthanasia in Switzerland may reflect the fear of dying and the belief that physicians and other medical professionals are not equipped to adequately care for the dying. Indeed, professional competence of palliative medicine to treat the symptoms of terminally ill patients particularly with cancer has frequently been insufficient. The majority of Swiss dying with assisted suicide (Switzerland belongs to the few countries where assisted suicide is not illegal) in 1996 and more than 80% in the Netherlands dying by euthanasia had cancer. For the terminally ill euthanasia and assisted suicide may seem the only solution. Enhancing education in palliative medicine is a necessary first step to improve the care for the dying patients.