Excellent palliative care as the standard, physician-assisted dying as a last resort

To understand the role of physician-assisted death as a last-resort option restricted to dying patients for whom palliative care or hospice has become ineffective or unacceptable, one must understand how frequently and under what circumstances that occurs. If all such cases are the result of inadequately delivered palliative care, then the best answer would be to improve the standard of care and make the problem disappear. Most experts in pain management believe that 95 to 98 percent of pain among those who are terminally ill can be adequately relieved using modern pain management,1 which is a remarkable track record?unless you are unfortunate enough to be in the 2 to 5 percent for whom it is unsuccessful. However, among hospice patients who were asked about their pain level one week before their death, 5 to 35 percent rated their pain as "severe" or "unbearable."2 An additional 25 percent reported their shortness of breath to be "unbearable" one week before death.3 This says nothing of the physical symptoms that are harder to relieve, such as nausea, vomiting, confusion, and open wounds, including pressure sores, which many patients experience.4