Intended for healthcare professionals

Feature Feature

The end of life

BMJ 2014; 348 doi: (Published 26 March 2014) Cite this as: BMJ 2014;348:g2261
  1. Leigh Page, freelance writer, 2525 North Talman Avenue, Chicago, Illinois, USA
  1. leighpage{at}

US physicians are more pressed than ever to deal with end of life care. Leigh Page looks at the issues

Increasingly, US physicians face legal risks for doing too much or too little to help patients with end of life issues. On one hand, doctors are under more pressure to hold discussions with people who are diagnosed with terminal illnesses—exploring whether they would want to stop treatment if it became ineffective. In that case, the patient would shift to palliative care, which involves pain medications and other therapies to enhance quality of life.

On the other hand, physicians may have terminally ill patients who are untreatable and want to die, but assisting in their suicide is illegal in most US states. In a few cases, physicians have been criminally convicted and sent to prison for helping a patient die.

Even talking about end of life issues can be distressing for physicians, because their overriding concern is to heal patients, said Timothy E Quill, a palliative care specialist in Rochester, New York. “When you’ve been fighting for a patient for a long time, it can be really hard to give up on treatment,” said Quill, who directs the Center for Ethics, Humanities and Palliative Care at the University of Rochester School of Medicine.

Quill said there are negative consequences, however, if physicians avoid talking about end of life issues with patients—as is often the case.1 Patients may never have the chance to choose options that could ease their deaths. And if they can’t talk about their desire for suicide, they are cut off from exploring other options, such as taking antidepressants or stronger pain medications.

Requirements to discuss end of life issues

When New York State passed a law in 20102 requiring physicians to discuss end of life options with patients diagnosed with a terminal illness, …

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