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November 9, 1994

Physicians and Their Patients' Suicides-Reply

JAMA. 1994;272(18):1410. doi:10.1001/jama.1994.03520180034029

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In Reply.  —Dr Grisolia's proposal to legalize physician-assisted suicide in a couple of test states will probably occur as a result of referendum, possibly as early as this fall. The larger infrastructure of suicide specialists, whom he euphemistically calls terminal care specialists, would be costly and a poor career choice until there was strong social approval and reimbursement for assisted suicide.The institutionalization of specialists in physician-assisted suicide that Grisolia proposes is another form of the "all or nothing" we both lament and the overspecialization that has fragmented and encumbered primary patient care. A middle ground may lie in fundamentally restructuring primary care systems for the common event of end-of-life care. We could assure universal access to hospice benefits to give patients a choice. We could minimize legal controls on narcotics for terminally ill persons to improve pain control, promote autonomy, decrease fear of loss of control, and empower nonmedical

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