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To the Editor: Dr Emanuel and colleagues¹ report that among terminally ill patients, those with depression, substantial caregiving needs, and pain were more likely to consider euthanasia or physician-assisted suicide (PAS). These 3 factors are commonly reversible using specific approaches such as psychiatric² and palliative care.³ Patients who are terminally ill often experience frustration, humiliation, or feelings of betrayal, leading to anger that may be unexpressed or unconscious. For some patients, lack of appropriate medical care leads to despair and hopelessness,⁴ and the patient's anger may assume the most efficacious form in which to be heard by caregivers and proxies: the demand for euthanasia or PAS. This approach is sometimes the only way for a patient to change treatment and care strategies. Rather than an autonomous wish, the expression of a desire for death by a terminally ill patient should be seen as a plea to change the context of . . . [Full Text of this Article]

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