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February 12, 2001

Terminal Sedation, Self-Starvation, and Orchestrating the End of Life

Arch Intern Med. 2001;161(3):329-332. doi:10.1001/archinte.161.3.329

IN THIS Commentary, I address some of the more recent problems and proposals made regarding end-of-life issues. Specifically, I address the question of orchestrating the end of life and put the recently raised issues of terminal sedation and self-starvation into that context. Patients who are at the end of their lives often ask that their physicians or, at times, families help them to hasten death. This is not because patients "want to be dead"—the life drive of most normal biological organisms militates against such a wish. The desire to be dead is generally not a desire to no longer be alive but an overwhelming feeling that being dead is preferable to "living this way." If, as is often the case, we can change the way in which patients live, the desire to die will vanish or, at the very least, diminish.

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