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J Palliat Care. 2018 Oct;33(4):197-203. doi: 10.1177/0825859718777325. Epub 2018 Jun 1.

Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective.

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1 General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
2 Professor of Bioethics, School of Medicine, The University of Notre Dame Australia, Sydney, Australia; Samuel Gale Professor of Law Emerita, Professor Faculty of Medicine Emerita, Founding Director of the Centre for Medicine, Ethics and Law Emerita, McGill University Montreal, Canada.
3 Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
4 General Internal Medicine specialist FMH, Palliative care practice, Geneva, Switzerland.
5 Center for Medical Law, Georg-August-University Göttingen, Göttingen, Germany.
6 Federal University of Rio Grande do Sul (Brazil), Medical Director-Pediatric Emergency and Critical Care, Department H Clinicas P. Alegre, Brazil.
7 Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore-Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
8 Kennedy Institute of Ethics and Pellegrino Center, Departments of Medicine and Philosophy, Georgetown University, Washington D.C., United States.
9 Department of Philosophy, Centre for Ethics, University of Antwerp, Belgium.
10 Department of Medicine, Vanderbilt University Medical Center and Veteran's Affair TN Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, United States.


Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn't be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients physically comfortable. Many individuals requesting PAS-E don't want to die but to escape their suffering. Adequate treatment for depression and pain decreases the desire for death; 4. Medical professionalism: PAS-E transgresses the inviolable rule that physicians heal and palliate suffering but never intentionally inflict death; 5. Differences between means and ends: Proeuthanasia advocates look to the ends (the patient's death) and say the ends justify the means; opponents disagree and believe that killing patients to relieve suffering is different from allowing natural death and is not acceptable.


Physicians have a duty to eliminate pain and suffering, not the person with the pain and suffering. Solutions for suffering lie in improving palliative care and social conditions and addressing the reasons for PAS-E requests. They should not include changing medical practice to allow PAS-E.


autonomy; euthanasia; palliative care; professional–professional relationship; suicide/assisted suicide

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