• R N Butler, R Burt, K M Foley, J Morris, and R S Morrison.
• Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, USA.
• Geriatrics. 1996 Jun 1; 51 (6): 32-5, 39-40, 42.

AbstractOne of the most important components of a peaceful death is adequate control of pain and other distressing symptoms, such as dyspnea, agitation, and restlessness. Pain is an important symptom in 75 to 80% of noncancer patients in the last year of life. Opioid analgesics are often the mainstay of pain treatment for dying patients. A primary care physician also needs to know about anesthetic and neurosurgical approaches, the use of cognitive behavioral approaches, and the availability of specialized pain experts. A sizeable minority of physicians receive requests for an assisted death, which should be seen as a cry for help. The most useful function of advance directives is that they open an avenue for discussion between the doctor and the patient about a difficult subject.

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