• Ralf J Jox, Ruth J Horn, and Richard Huxtable.
• Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilian University Munich, Munich, Germany. Electronic address: ralf.jox@med.uni-muenchen.de.
• Handb Clin Neurol. 2013 Jan 1;118:155-65.

AbstractEnd-of-life care practices and attitudes in Europe are highly diverse, which is unsurprising given the variety of cultural and religious patterns across this region. The most marked differences are in the legal and ethical stances towards assisted dying, although there are also variations in limitation of life-sustaining treatment and the authority of advance directives to decline such treatment. Palliative care has made a rapid and impressive development in many European countries over the last decade, and alleviating symptoms at the end of life is permitted, even if the drugs used might (in the rare case) not only relieve suffering but also shorten life. Fueled by the politically led process of European harmonization, future policies and laws on end-of-life care might converge. However, at the base of many ethical conflicts there remain deeply rooted differences about promoting the sanctity of life, eradicating suffering, and respecting patients' autonomous wishes.© 2013 Elsevier B.V. All rights reserved.

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