I have assisted patients in ways that have undoubtedly hastened their deaths, though that wasn't my goal. For example, I've given pain medications that contributed to respiratory depression. In those circumstances, I believed I was taking the "right" and legal action.

Yet I'm uncomfortable with the way Schwarz has suggested we give patients information about how they can hasten their deaths. Hastening death has connotations of an individual's self-determination over her or his life and death that doesn't honor the gift that each person-and every moment of life-is. I fear that when the emphasis is on the patient's right to decide when to die, our patients may be left feeling expendable.

It seems to me it would be better to reframe the question. First, we need to determine why patients wish to hasten their deaths: Fear of pain? Fear of being alone? Desire to be in control? Not wanting to be a burden? Once we understand their concerns, we can assure patients that we will help them have a "good" death and they'll be comfortable, even if that requires palliative sedation. We can assure them that they're not burdens but gifts, even if we must work hard and creatively to make that happen for our patients and their families.

Vienna, VA