Palliative Options at the End of Life

To the Editor.—Dr Quill and colleagues¹try to minimize logically the differences between voluntarily stopping eating and drinking (VSED) and 3 physician-based actions: terminal sedation (TS), physician-assisted suicide (PAS), and voluntary active euthanasia (VAE). The authors propose categories of safeguards to minimize the abuse of these physician-based actions, apparently believe that TS, PAS, and VAE should be accepted medical procedures, and even suggest that "physicians who choose not to participate because of personal moral considerations should at a minimum discuss all available alternatives in the spirit of informed consent and respect for patient autonomy."