IN THEIR Commentary, "Patient Refusal of Hydration and Nutrition: An Alternative to Physician-Assisted Suicide or Voluntary Active Euthanasia," Bernat et al1 provide a timely and helpful suggestion for handling "routine" end-of-life options (ie, cases in which a patient is competent and conscious, capable of expressing wishes). Their Commentary argues persuasively that willingness of physicians to withdraw hydration and nutrition from such patients provides a humane option for patients who elect it—and one that avoids legal and ethical difficulties raised by the more commonly advocated alternative of physician-assisted suicide.
The article can and should be read at a number of different levels. It invites and demands responses at the level of its practical advice, its discussion of political and institutional adequacy to the problems of care of the chronically and terminally ill, and at its deepest level to the concept of medicine it reflects and advocates, at times only implicitly.
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