Euthanasia debates have focused on suffering, respect for patient autonomy, and dignified death, but little evidence is available from patients who desire euthanasia.

A few studies have shown that patients' reasons for wanting euthanasia are not confined to the physical effects of disease, but relate to their whole life experiences. However, more studies are urgently needed to capture their voices, say the authors.

Rather than focusing on assessing the mental competence of patients requesting euthanasia or determining clear legal guidelines, doctors must acquire the skills for providing good end of life care, they add. These include the ability to "connect" with patients, diagnose suffering, and understand patients' hidden agendas through in-depth exploration.

There is much to ponder over the meaning of a euthanasia request before we have to consider its justification. The desire for euthanasia must not be taken at face value, they conclude.

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Contact: Emma Dickinson
edickinson@bmj.com
44-0-20-7383-6529
BMJ-British Medical Journal
24-Jul-2003