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November 9, 1994

Physicians and Their Patients' Suicides

Author Affiliations

University of California—San Diego

JAMA. 1994;272(18):1410. doi:10.1001/jama.1994.03520180034028

To the Editor.  —Dr Miles1 expresses a reasoned reluctance to sanction euthanasia or physician-assisted suicide. Although I share his reluctance, plainly the status quo is unsatisfactory to patients and physicians. Since suicide remains a forbidden topic, patients already determined to commit suicide must deceive their own physicians, whereas undecided patients feel unable to bring up the issue, inhibiting the free discussion of alternatives to suicide. In terminal care, the murkiness surrounding euthanasia confounds adequate pain control and sedation; many physicians fail to give adequate treatment from exaggerated fear of hastening death, while other physicians prescribe excessively as covert euthanasia. The net result—patients fooling physicians, physicians fooling themselves, and physicians fooling others with misleading documentation.A recent survey of British physicians2 demonstrates the extent of the problem: 45% had been asked by patients to actively assist death. Of these, 32% admit covertly assisting euthanasia, despite legal proscription. Quill3

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