Physician-assisted suicide in the United States: the underlying factors in technology, health care and palliative medicine--Part one.

In an age of rapid advances in life-prolonging treatment, patients and caregivers are increasingly facing tensions in making end-of-life decisions. An examination of the history of health care in the United States reveals technological, economic, and medical factors that have contributed to the problems of terminal care and consequently to the movement of assisted suicide. The movement has its roots in at least two fundamental perceptions and expectations. In the age of technological medicine energized by the profit motive, dying comes at a high price in suffering and in personal economic loss. The failure to provide affordable resources for terminal care is the result of the marketplace in health care. The medical profession has been painfully slow in responding to the challenges of terminal care, mainly because of the pressures of the marketplace and lack of adequate training. This has occurred at a time of rapid advances in life-sustaining treatment and of expanding public awareness of personal rights under the law. Overly aggressive treatment in the final stages of terminal illness has enhanced anxieties over a painfully prolonged and expensive dying. These factors have promoted the movement to assisted suicide. In the U.S. debate of the issues, ethicists tend to argue abstractly without examining adequately the context of terminal care that is the health care system. It is a system in dire need of a reform that will remove it from the marketplace.