To the Editor.
—The study by Dr McCann and colleagues1 provides much-needed data on whether starvation and dehydration contribute to or alleviate the suffering of terminally ill patients. Though not addressed in their discussion, the data they collected also contribute to another important debate in which the medical community is currently involved, namely, the appropriateness of physician-assisted suicide and euthanasia.Much of this debate turns on the assumption that death without "assistance" from a physician is likely to involve unnecessary suffering. Hence, both the lay public and the medical professional community have expressed a willingness to consider these two practices as public policy despite the many risks such a policy would engender.2 Voluntary patient refusal of food and fluids has been offered as an equally effective but less ethical and pragmatically risky response to the problem of unbearable suffering under hopeless circumstances.3 The finding by McCann et
Mogielnicki RP, Bernat JL, Gert B. Nutrition and Hydration for the Terminally III. JAMA. 1995;273(22):1736-1737. doi:10.1001/jama.1995.03520460018015