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Physicians whose patients disclose a wish to die must always be listening for underlying deep sorrow, the source of which may or may not be self-evident or readily accessible.1 For some patients, requesting a hastened death may be the ultimate assertion of individual autonomy. The impulse of physicians to pursue these conversations, to try to unravel the etiology of a desire for death, can sometimes be temporized by the uncertainty of where those discussions might lead and the question of how best to respond. In countries having or about to have legislation allowing for death-hastening options, these conversations are now simply unavoidable.
Chochinov HM. Physician-Assisted Death in Canada. JAMA. 2016;315(3):253-254. doi:10.1001/jama.2015.17435