Legal and Ethical Concerns

Many health care practitioners worry that medical treatments intended to relieve pain or other suffering can hasten death, but such treatments rarely do; relieving dyspnea or pain may even prolong life. When treatment of symptoms, even at the risk of hastening death, is best for a dying patient, health care practitioners are ethically bound to do so. Thus, opioids should be used to relieve suffering (eg, dyspnea) even though they could cause respiratory depression.

Assisting with suicide remains a criminal act in most states, but laws vary substantially and are rarely invoked, particularly if opioids are used appropriately to relieve suffering. Directly providing a dying patient with lethal drugs and instructions for using them is grounds for prosecution in all states except Oregon. In Oregon, the Death with Dignity Act provides for physician-assisted suicide under strict regulations. Patient requests for assisted suicide should be seen as an opportunity to explore causes of the patient's suffering, which in almost all cases can be managed with education, specific treatment for symptoms, and support for the patient's and family members' social and existential distress. Health care practitioners who manage symptoms vigorously and forgo life-sustaining treatment need to document decision making carefully, provide care in a reputable setting, and be willing to discuss these issues honestly and sensitively with patients, other practitioners, and the public.

This topic was last updated July 2006.