Personal experience as well as research and media coverage have given many in our society every reason to fear the prospect of a dehumanizing, prolonged, and painful death. There is increasing evidence that, even though contemporary medicine has attained undreamed-of advances and sophistication in medical care and research, health professionals in many societies still deal abysmally with treatment at the end of life. Must there be such a contrast between advances in medical care and widespread failures to deal adequately with care at the end of life? And is the only way out that of allowing, for those who so choose, some form of euthanasia or physician-assisted suicide?

Such questions arise with unprecedented frequency in affluent modern democracies. In most, life expectancies have almost doubled in little over a century. All who have seen relatives die in hospitals – where over 80 percent of Americans now die – know that the medical procedures that are so vastly more capable of holding death at bay can also greatly prolong the process of dying. Laws have been instituted mandating the right of individuals to accept or refuse such procedures; but even these laws, so forceful on paper, are often disregarded in health care settings. It is only natural for anyone witnessing the neglect and suffering of persons at the end of life to seek alternatives giving patients more say about how they are to be treated.