Physicians should "assist in suicide" when it is appropriate.

Area of Science:

• Medical Ethics
• Palliative Care
• End-of-Life Care

Background:

• Palliative care and hospice aim to be the standard for terminally ill patients.
• Adequate palliative interventions are the primary response to requests for assisted death.
• A small subset of patients experience intolerable suffering despite optimal palliative care.

Purpose of the Study:

• To explore interventions for patients with intractable end-of-life suffering.
• To examine the role of palliative care in addressing requests for physician-assisted death.
• To outline a framework for responding to end-of-life suffering while respecting patient values.

Main Methods:

• Review of potential "last resort" interventions for end-of-life suffering.
• Analysis of the ethical considerations surrounding physician-assisted death.
• Discussion of patient, family, and clinician collaboration in decision-making.

Main Results:

• Five "last resort" interventions are identified: accelerated opioids, stopping life-prolonging therapies, voluntarily stopping eating/drinking, palliative sedation, and physician-assisted death.
• The focus should be on finding the least harmful, effective intervention that respects participant values.
• A system allowing open responses ensures thorough evaluation and alternatives.

Conclusions:

• Palliative care is foundational, but "last resort" options are necessary for refractory suffering.
• Physician-assisted death is one of several potential interventions for extreme end-of-life suffering.
• Open clinical evaluation and responsiveness are vital to avoid abandoning patients facing intolerable suffering.