[Patients dying in institutions. A medical and human challenge]

Over 40,000 people die in Norway every year. About 80% die in institutions and 2/3 are over 70 years old. The debate about terminal care and euthanasia is often based on unusual and extreme situations. The great challenge, however, is found in the quite ordinary routine conditions in our hospitals and institutions for the elderly. The continuing debate concerning active euthanasia hides several realities; fear of disease, worry about physical and mental disability, loss of dignity and autonomy and concern about dependence and helplessness in the last phases of life. Resolving some of these issues requires that the physician is aware of the true condition of the patient and communicates this knowledge in a caring and respectful manner. The patients' wishes must be weight against appropriate treatment.