Palliative Care vs Euthanasia: Hospice, Pain Relief and Support

On 18 February 2023, the Carter Center shared some news. Former US President Jimmy Carter was 98. He had "decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention."

Many people read that as a goodbye. So did his family. "When he went into hospice, we thought it was a matter of days, weeks, really," his grandson Jason Carter said later, as reported by the Atlanta Journal-Constitution.

Days became months. Seven months in, PEOPLE reported that he was still watching baseball at home. "These last several months have been surprising for all of us, but it's been a real blessing," Jason said.

In November 2023, his wife Rosalynn entered hospice at their home in Plains, Georgia. She died two days later, aged 96 (The Independent). They had been married for 77 years. "Rosalynn was my equal partner in everything I ever accomplished," he said in a statement. Hospice gave him time to be beside her at the end.

He turned 100 on 1 October 2024. He was "very physically diminished," Jason said. But he still liked to talk about his baseball team, the Atlanta Braves, and he wanted to vote in the 2024 election. He died at home in Plains on 29 December 2024, about 22 months after he entered hospice.

His story is unusual. Among Medicare patients who died in hospice care in 2022, only about 10% had stays of 275 days or longer, according to the US Medicare Payment Advisory Commission (MedPAC). But it shows something many people do not know. Hospice and palliative care are not about "giving up." They are about living as well as possible for the time that is left, however long that is.

This guide explains what palliative care is and what decades of research show. It also explains where palliative care stops, and why it sits at the centre of every debate about euthanasia and assisted dying.

Palliative care is medical care for people with a serious illness. It relieves pain, other symptoms and stress. The word comes from the Latin pallium, a cloak. Like a cloak, it covers and protects the person when the illness itself cannot be removed.

The World Health Organization (WHO) says it improves quality of life for patients and their families. It treats problems that are physical, psychological, social and spiritual. It "offers a support system to help patients live as actively as possible until death." WHO also says palliative care is part of the human right to health.

Five key ideas:

• It treats the whole person, not only the disease. Your fear, your family and your sense of meaning count as much as your blood tests.
• It neither hastens nor postpones death. The aim is comfort and quality of life. It is not to end life, and it is not to stretch life out at any cost.
• It is team care. A team usually includes doctors, nurses, social workers, chaplains (spiritual care workers) and other specialists.
• It is for any age and any stage. You do not have to be dying. It can start on the day of diagnosis.
• It works alongside other treatment. Treatment that tries to cure the illness is called curative care. Palliative care can run at the same time. As a cure becomes less likely, palliative care becomes the main focus.

It is not only for cancer. WHO says most adults who need palliative care have heart disease (38.5%), cancer (34%), chronic lung disease (10.3%), AIDS (5.7%) or diabetes (4.6%). Kidney failure, liver disease, dementia, Parkinson's disease and multiple sclerosis also qualify.

Here is a simple picture. Your cancer doctor or heart doctor is like a pilot. Their job is to fly the plane: to treat the disease. The palliative care team is like the cabin crew. Their job is to make the journey bearable for you and for the people travelling with you. A good flight needs both.

Modern palliative care began with one woman and one patient.

In 1948, Cicely Saunders was a young medical social worker at St Thomas' Hospital in London. She had trained as a nurse first. One of her patients was David Tasma, a Polish Jewish migrant who was dying of cancer. Historian David Clark told Hospice UK that Tasma's worst pain was not physical. He had left his family behind when he fled Poland before the Second World War, and he had lost contact with them. He had given up his faith. He was dying on a "busy, noisy hospital ward."

Saunders and Tasma talked about a better place for people like him. When he died, he left her £500. Words attributed to him became famous: "I'll be a window in your home."

Saunders then trained as a doctor, starting in 1951, when she was in her thirties. In 1967 she opened St Christopher's Hospice in London. It joined expert pain control, research and teaching with a homely setting. As her biography notes, patients could garden, write, talk and even get their hair done.

Her most important idea was "total pain." She saw that suffering at the end of life has four parts: physical, emotional, social and spiritual. Treating only the body is not enough. Every palliative care team in the world today is built on this idea.

Her best-known words are still used in hospices everywhere:

"You matter because you are you. And you matter until the end of your life." (Dame Cicely Saunders, as quoted by Hospice UK)

Saunders died in 2005, aged 87, at the hospice she founded.

People often mix up the two words. The difference matters, because it affects when you can get help.

Hospice is a type of palliative care. It is for people whose illness is expected to end their life. In the US, Medicare pays for hospice when doctors certify that a person is terminally ill. This means a life expectancy of 6 months or less if the illness follows its normal course. The person also accepts comfort care instead of curative treatment for that illness.

Four details that surprise many families:

• Hospice is not limited to 6 months. Medicare covers two 90-day periods, then an unlimited number of 60-day periods. A doctor must recertify the person each time. Jimmy Carter's 22 months show how this works.
• You can leave hospice. If your health improves, or you want to try curative treatment again, you can stop hospice and return later.
• Hospice includes a lot. It covers visits from doctors and nurses, aides for personal care, and medicines and equipment for the terminal illness. It also includes counselling, spiritual care, short "respite" stays to give carers a break, and grief support for the family.
• It usually happens at home. Hospice also works in nursing homes, hospitals and hospice units.

Under Medicare, you pay nothing for covered hospice services, though other costs may apply. For example, Medicare does not pay for room and board at home or in a nursing home. Hospice use is now common. In 2024, more than 1.8 million Medicare patients used hospice. That was 52.9% of all Medicare patients who died, a new high, according to MedPAC.

The biggest myth is that hospice means giving up. It means changing the goal from cure to comfort. People in hospice still get active, skilled care. A second myth, that hospice makes people die sooner, is tested in the sections below.

For decades, palliative care came only at the very end. Then a landmark study changed the conversation.

In 2010, Dr Jennifer Temel and her team at Massachusetts General Hospital published a trial in the New England Journal of Medicine (Temel et al., NEJM 2010). They studied 151 people just diagnosed with lung cancer that had spread (metastatic non-small-cell lung cancer). Half got normal cancer care. The other half also met a palliative care team soon after diagnosis.

After 12 weeks, the early palliative care group had:

• Better quality of life (98.0 vs 91.5 points on a standard scale)
• Less depression (16% had depressive symptoms, compared with 38%)
• Less aggressive care at the end of life (33% vs 54%)
• Longer survival (a median of 11.6 months vs 8.9 months)

Fewer hospital treatments, yet nearly three extra months of life. The result surprised many doctors.

But one study is not the whole story. Later research gave a more careful picture:

• A Canadian trial of 461 people with advanced cancer (Zimmermann et al., Lancet 2014) found no clear difference in its main measure at 3 months. By 4 months, quality of life and satisfaction with care were better in the palliative care group.
• A Cochrane review of 7 trials and 1,614 people (Haun et al., 2017) found that early palliative care improved quality of life and symptoms by a small amount. It could not confirm any effect on survival or depression. The authors rated the certainty of the evidence as low to very low.
• A meta-analysis of 43 trials and 12,731 patients (Kavalieratos et al., JAMA 2016) linked palliative care to better quality of life and fewer symptoms. It was also linked to more advance care planning, more satisfied patients and families, and less hospital use. It found no effect on survival in either direction. When only the highest-quality trials were counted, the benefits became smaller.

What this means for you: Starting palliative care early is likely to help you feel better, and it does not appear to harm you. The size of the benefit varies. The claim that it helps people live longer is promising but not proven.

Evidence: strong that palliative care improves quality of life and planning; mixed on depression; early and mixed on survival.

This is one of the most common fears. Many families worry that hospice, or strong pain medicine, will make their loved one die sooner. The research does not support this fear.

• Hospice and survival. A study of 4,493 Medicare patients with cancer or heart failure (Connor et al., 2007) found that hospice patients lived on average 29 days longer than similar patients without hospice. The gain was clearest for heart failure, lung cancer and pancreatic cancer. There was no difference for breast or prostate cancer. This was an observational study, not a trial. People who choose hospice may differ in other ways, so the result needs care. But hospice was not linked to shorter survival.
• Pain medicine and survival. A review in Lancet Oncology (Sykes and Thorns, 2003) found "no evidence" that starting or increasing opioid pain medicine, or sedatives, was linked to an earlier death. Doses often rise as death comes closer, but the review found no sign that the higher doses caused death. The authors warned that the fear itself can stop people getting good symptom control.
• Palliative sedation and survival. A review of 1,807 patients (Maltoni et al., 2012) found that patients who received palliative sedation did not die sooner than those who did not.

Dr Tammie Quest, who directs Emory University's Palliative Care Center, put it simply to the Atlanta Journal-Constitution: "People who feel better live longer."

Evidence: mixed to strong that hospice and good symptom control do not shorten life (observational studies and reviews, few randomised trials).

Pain is the symptom people fear most. The good news is that most pain can be controlled well. The bad news is that many people still do not get the treatment that exists.

How common is pain? WHO says that 80% of people with AIDS or cancer, and 67% of people with heart disease or chronic lung disease, have moderate to severe pain at the end of life. A 2023 review of 444 studies of people with cancer (Snijders et al.) found pain in 44.5% overall, and moderate to severe pain in 30.6%. Both numbers have fallen over the past decade, which suggests better attention to pain is working.

Different pain, different treatment. Pain can come from damaged tissue, from damaged nerves (often burning or shooting), from organs such as the bowel or liver, or from cancer in the bones. Most people have more than one type. That is why teams ask detailed questions before they treat.

Treatment. Doctors match the medicine to the type and strength of pain. Moderate to severe pain usually needs opioids, the morphine family of strong pain medicines, given on a regular schedule. Physiotherapy, massage, relaxation and cognitive behavioural therapy (CBT), a talking therapy that changes how you respond to pain, can all help. For some people, procedures such as nerve blocks, or radiotherapy for bone pain, give strong relief.

Measuring pain. Teams ask people to rate their pain from 0 to 10, or to point to a row of faces. For people who cannot speak, such as those with advanced dementia, nurses watch for frowning, moaning or tense muscles. A basic rule of palliative care is this: pain is what the patient says it is.

Why is pain still undertreated? A review of 46 studies (Greco et al., 2014) found that about one in three people with cancer pain still did not get pain medicine matched to how much pain they had. That was an improvement from about 43% earlier. Common barriers are fear of addiction, fear of side effects, staff without enough training, poor pain assessment, and, in many countries, laws and supply problems that limit access to opioids.

Facts about opioids at the end of life. The body gets used to opioids over time, so the dose may need to change. This is called tolerance. Physical dependence is expected and can be managed. It is not the same as addiction. In skilled hands, serious side effects are uncommon. The most common ones, constipation and nausea, can be treated.

Pain is only one part of the picture. Other symptoms can be just as distressing.

• Breathlessness. This is one of the most frightening symptoms. A fan blowing gently on the face, changing position and carefully prescribed medicine can ease the feeling of "air hunger."
• Nausea and fatigue. The team looks for the cause, such as a medicine, constipation or anaemia (low red blood cells), and treats that. Pacing your day helps with deep tiredness.
• Anxiety and depression. These are common, often missed and treatable. They can make pain feel worse. Counselling, medicine and spiritual support all play a part. Depression is not a normal part of dying. It deserves treatment like any other illness.
• Delirium. This is sudden confusion, restlessness or drowsiness. It is very common near the end of life. Treatment depends on the cause and on the person's goals.
• Loss of appetite. Eating less is a natural part of the body slowing down. Forcing food rarely helps. Offer small amounts of foods the person enjoys. In advanced illness, tube or drip feeding rarely helps and can cause harm, such as swelling and breathing problems.

Saunders called it "total pain" for a reason. Some of the deepest suffering at the end of life has nothing to do with the body.

Coping with a terminal diagnosis. People react in many ways: shock, denial, anger, bargaining, sadness, acceptance. Psychiatrist Elisabeth Kübler-Ross described these as "stages" in 1969. By 1974, she wrote that most of her patients showed "two or three stages simultaneously," in no fixed order. Later researchers found no good evidence that people move through set stages. Good teams do not push people through a script. They let the patient lead, accept grief and fear, and never force "positive thinking."

Existential distress. This means suffering about meaning: "Why me?", "What was my life for?", "Will I be forgotten?" It can include a crisis of faith. It can hurt as much as physical pain, and it needs skilled human support, not only medicine.

Dignity therapy. Canadian psychiatrist Harvey Chochinov developed dignity therapy. A trained therapist asks a person about their life: what they are proudest of, what they want their family to know, what they hope for the people they love. The answers are recorded, edited into a written document and given to the person to share.

The largest trial included 441 terminally ill patients in Canada, the US and Australia (Chochinov et al., Lancet Oncology 2011). Dignity therapy did not reduce distress, such as depression, more than the other groups. But patients who had it were much more likely to say it had helped. They said it improved their quality of life, increased their sense of dignity, and changed how their family saw and valued them.

Evidence: mixed. Patients and families value dignity therapy, but it has not been shown to reduce depression or a wish to die.

Meaning, legacy and faith. Other approaches include life review (looking back on one's life story), legacy projects such as letters, videos or recipes, and saying thanks, sorry and goodbye. Chaplains support people of every faith and none. For non-religious people, spiritual care may focus on nature, music and the people they love. Everyone needs meaning, connection and peace.

Serious illness happens to a whole family. Palliative care treats the family as part of the "unit of care." Family carers often face exhaustion, broken sleep, grief, lost income and isolation, and their own health often declines.

Honest conversations help families too. The Coping with Cancer study followed 332 patients with advanced cancer and their carers (Wright et al., JAMA 2008). Patients who had talked with their doctor about end-of-life care were less likely to be put on breathing machines (1.6% vs 11.0%) and more likely to join hospice early. These talks did not make patients more depressed. Patients who had more aggressive care had worse quality of life, and their bereaved carers had a higher risk of major depression afterwards.

Family meetings. The care team and the family meet to discuss the illness, the likely future and the goals of care. Everyone hears the same information. Palliative care pioneer Dr Susan Block told the surgeon and writer Atul Gawande (The New Yorker, 2010):

"A family meeting is a procedure, and it requires no less skill than performing an operation."

Block also shared a personal story. Before her father had risky spinal surgery, she asked him how much he was willing to go through to stay alive. His answer shocked her. If he could still eat chocolate ice cream and watch football on TV, he was willing to go through a lot of pain. After the surgery, he had bleeding in his spinal cord. The surgeons needed an answer fast: operate again, knowing he might stay severely disabled, or not? "I had three minutes to make this decision, and, I realized, he had already made the decision," Block said. She asked one question: would he still be able to eat ice cream and watch football? Yes. She said go ahead.

Notice that the talk did not lead to "less" care. It led to the care he wanted. That is the gift of these conversations. They lift an impossible choice off the shoulders of the people we love. If you are not sure how to begin, our guide on how to talk to your family about end-of-life wishes suggests what to say first.

Respite care. Respite means a short break for carers. It can be a volunteer visitor, a day programme, or a short stay for the patient in a hospice or care home. The Medicare hospice benefit covers short inpatient respite stays.

Grief support. Support starts before the death, with "anticipatory grief," and continues after it. In the US, Medicare rules require hospices to offer bereavement services to the family for up to a year after the death.

Practical help. Social workers help families apply for benefits and manage the costs of medicines, equipment and bills. They can also help with wills, power of attorney and advance directives.

Palliative care works. Yet most people in the world who need it do not get it.

The global gap. WHO estimates that each year 56.8 million people need palliative care, including 25.7 million in their last year of life. Only about 14% receive it. Most live in low- and middle-income countries. The gap in pain relief is extreme. In 2018, 79% of the world's population, mostly in poorer countries, used only 13% of the morphine used for pain and suffering, WHO says.

The Lancet Commission on Palliative Care and Pain Relief (2018) called this an "access abyss." The need is growing fast. A study in Lancet Global Health (Sleeman et al., 2019) projects that by 2060, 48 million people a year will die with serious health-related suffering. That is 47% of all deaths worldwide and an 87% rise from 2016. The fastest rise is expected in dementia.

The rich-world gap. Wealthy countries struggle too. The famous SUPPORT study followed 9,105 seriously ill adults in five US teaching hospitals (JAMA, 1995). It found that:

• only 47% of doctors knew when their patients did not want resuscitation (CPR)
• 46% of do-not-resuscitate orders were written within 2 days of death
• 38% of patients who died spent at least 10 days in intensive care
• for half of conscious patients who died in hospital, family members said they were in moderate to severe pain at least half the time

Then the researchers tried to fix it. Specially trained nurses worked with patients, families and doctors to improve communication. The intervention failed to improve any of its five main targets. The lesson was hard. Better information alone does not change how people die. That needs deep changes in systems and culture.

Late referrals. US hospice use is at a record high, but people often arrive very late. In 2024, the median hospice stay for Medicare patients who died was 19 days, according to MedPAC. Half had less time than that.

In "Letting Go," Gawande described an experiment by the insurer Aetna. Patients with less than a year to live could get hospice services without giving up other treatment. Hospice use jumped from 26% to 70%. Then came the surprise: they chose less hospital care. They went to the emergency room almost half as often, and their use of hospitals and intensive care fell by more than two-thirds. When people did not have to choose between hope and comfort, many chose comfort sooner.

The Lancet Commission on the Value of Death (2022) wrote that "the story of dying in the 21st century is a story of paradox." Many people are overtreated in hospital, while still more die without basic pain relief. In high-income countries, 8% to 11.2% of yearly health spending goes on the less than 1% of people who die that year. The Commission called for "bringing death back into life."

Sometimes symptoms cannot be controlled, even with excellent care. Doctors call these refractory symptoms. Examples include severe agitated delirium or breathlessness that nothing else relieves.

For these rare cases, doctors may use palliative sedation. This means giving medicine to lower a person's awareness, so they no longer feel the distress. Sometimes the sedation is light or short. In the most serious cases, near the end of life, it may continue until death comes from the illness.

The European Association for Palliative Care (EAPC) calls sedation "an important and necessary therapy" for selected patients with otherwise refractory distress (Cherny and Radbruch, 2009). It also warns that careless use can lead to "harmful and unethical practice," so it set out a 10-point framework for safe practice.

How is it different from euthanasia? Supporters of the distinction point to three things:

1. Intention. The aim of sedation is to relieve suffering. The aim of euthanasia is to end life.
2. Proportion. Sedation is adjusted to the lowest level that brings relief. Euthanasia is meant to cause death.
3. Outcome. In sedation, the illness causes death. Reviews have not found that palliative sedation shortens survival.

This reasoning draws on the doctrine of double effect, an old idea from Catholic moral thought. It says an action with a good aim, such as relieving pain, can be acceptable even if it has a bad side effect that is foreseen. The bad effect must not be the goal, and the reason must be serious enough. The US Supreme Court used similar reasoning in Vacco v. Quill (1997). It said that when a doctor gives "aggressive palliative care," the doctor's "purpose and intent" may be "only to ease his patient's pain." The Court ruled that states may allow such care and refusal of treatment while still banning assisted suicide.

Not everyone agrees the line is clear. In 1975, philosopher James Rachels argued in the New England Journal of Medicine (Rachels, 1975) that the distinction between killing and letting die "itself has no moral importance." In 1997, palliative care doctor Timothy Quill and colleagues (JAMA, 1997) compared terminal sedation with assisted dying. They concluded that sedation is "ethically and clinically more complex and closer to" assisted dying "than is ordinarily acknowledged." They called for clear public rules and safeguards for any medical act that may hasten death. Read more in our section on ethics and philosophy.

This question sits at the heart of the euthanasia debate. The honest answer is: most, but not all.

What it does well. Expert palliative care can control most pain and many other symptoms. It can treat depression and anxiety. It supports families. It can help people find meaning and peace.

Where it reaches its limits. Some physical symptoms stay hard to control, even with expert care. And some suffering is not about symptoms at all. It is about losing independence, identity or the ability to do what makes life feel worth living.

The reasons people give for assisted dying show this clearly. In Oregon in 2025, the three most common end-of-life concerns among people who died under the Death with Dignity Act were (Oregon Health Authority):

• loss of autonomy (89%)
• being less able to take part in activities that make life enjoyable (89%)
• loss of dignity (65%)

Being a burden on family, friends or carers was named by 40%. Inadequate pain control, or concern about it, was named by 37%. Concern about pain is often fear of the future, not pain that is happening now.

A wish to die can change. In a landmark 1995 study, Chochinov and colleagues interviewed 200 terminally ill patients (American Journal of Psychiatry). Passing wishes that death would come soon were common (44.5%). But only 8.5% had a serious and lasting desire to die. That desire was most strongly linked to depression, which is treatable. Of six patients interviewed again two weeks later, the wish to die had become weaker in four. The authors said any informed debate about euthanasia must take these facts into account.

Evidence: early. One small study, but its findings shaped how teams respond to a wish to die.

This is why good care means asking gently about a wish to die, and treating depression when it is present. A wish to die is often a sign of suffering that needs attention, not a fixed decision. If you are having thoughts of ending your life, please reach out for support now. Our help page lists free, confidential services.

Two honest views. People who support assisted dying say that even perfect palliative care cannot meet every need. In the UK's September 2026 debate, Labour MP Claire Hazelgrove spoke about her mother, who had lived with a rare blood cancer for half her life. She argued that "not all pain can be palliated" (BBC News). People who oppose assisted dying say that much of the suffering behind requests comes from poor care, loneliness and fear, and that society should fix these first.

Ask yourself: if you were seriously ill, which would matter more to you: being free of pain, or staying in control of your own choices? There is no right answer. But knowing your own answer helps you talk to the people who may one day speak for you.

A common belief is that people ask for assisted dying because they cannot get palliative care. In most places with official data, the numbers do not show this.

• Oregon (2025): Of 400 people who died under the Death with Dignity Act, 92% were enrolled in hospice (Oregon Health Authority). The median age was 76, and most (61%) had cancer. Since the law began in 1997, 5,520 people have received prescriptions and 3,691 have died after taking the medication. Across all years, 91% were in hospice.
• Canada (2024): 16,499 people received medical assistance in dying (MAID), or 5.1% of all deaths (Health Canada, Sixth Annual Report). 74.1% had received palliative care. Only 2.5% needed palliative care but did not receive it, and clinicians said 91.2% of that small group could have accessed it. The median age was 77.9. Among people whose death was reasonably foreseeable, the most common sources of suffering were losing the ability to do meaningful activities (95.1%) and losing the ability to do daily tasks (85.4%).
• The Netherlands (2025): The Regional Euthanasia Review Committees received 10,341 reports, or about 6% of all deaths (RTE). Dutch law requires the doctor and patient to conclude together that "there is no reasonable alternative." The review committees explain that this depends on how much a curative or palliative treatment could help and how heavy a burden it would be. Patients may refuse a treatment, including palliative care.
• Belgium (2025): 4,486 people had euthanasia, about 4% of all deaths, and half had cancer (The Bulletin, reporting official commission figures). Belgium's 2002 law requires that patients who ask for euthanasia be told about palliative care options (Bernheim et al., BMJ 2008).

A major review in JAMA (Emanuel et al., 2016) looked at data from the US, Canada and Europe. It found that pain is mostly not the main reason for requests. It also found that a large share of patients in Oregon, Washington and Belgium were enrolled in hospice or palliative care.

There is an important exception. In Canada, people whose natural death is not reasonably foreseeable can also qualify for MAID. This group is called "Track 2." In 2024, only 23.2% of Track 2 recipients had received palliative care, compared with 76.4% in Track 1. Isolation or loneliness was a source of suffering for 44.7% of Track 2 recipients, compared with 21.9% in Track 1. Critics see this as a sign that some people ask to die because their needs for care and support are not met. Supporters reply that palliative care is often not designed for people who are not dying.

This is where reasonable people disagree most deeply.

The "partners" view: Belgium's integral palliative care. In Belgium, the palliative care movement and the campaign for euthanasia grew up side by side from the 1980s. In 2002, Parliament passed a palliative care law and a euthanasia law in the same year. A 2008 BMJ article (Bernheim et al.) described a model called "integral palliative care." In it, euthanasia is one option at the end of a palliative care pathway, and the patient's wishes come first. The Flemish Palliative Care Federation endorsed this model in 2003. The authors argued that palliative care grew stronger, not weaker: in 2007, Belgium ranked third of 52 European countries for palliative care resources. But the law did not require a palliative care team to be consulted before euthanasia, as the Federation had wanted. Two of the authors said openly that they were active in both movements.

The "rivals" view: palliative care organisations. Many palliative care professionals believe that ending life has no place in their work, because palliative care "neither hastens nor postpones death." In 2016, the EAPC published a white paper after a five-round expert consensus process (Radbruch et al.). It concluded that "complete consensus seems to be unachievable due to incompatible normative frameworks that clash." In plain words, people hold different basic values, and research alone cannot settle the question.

Atul Gawande raised a related worry in his 2014 book Being Mortal (New York Times review). He wondered whether the Dutch had been slow to build palliative care because assisted death "may have reinforced beliefs that reducing suffering and improving lives through other means is not feasible." Supporters of assisted dying point to Belgium as evidence that both can grow together.

Evidence: mixed. Countries differ, and it is hard to prove what causes what.

Religious voices. The Catholic Church's 2020 letter Samaritanus bonus strongly supports palliative care and calls for it to reach everyone who needs it. Its guiding phrase is "to cure if possible, always to care." It says that "the employment of palliative care reduces considerably the number of persons who request euthanasia." It also objects to laws that place assisted dying under the name of palliative care, calling this "a cause of grave cultural confusion." The Oregon and Canada data above suggest the picture is more complex, since many people who choose assisted dying already receive palliative care.

In Islam, scholars widely forbid ending a life to relieve suffering. But a review of Islamic juridical rulings found that futile life support, such as a breathing machine, may be withheld or withdrawn. Rulings that address it add that basic care, including food, fluids and pain control, should continue. Most major faiths share this pattern: comfort care is welcomed, and ending life on purpose is not. See our section on religious views for more.

Disability rights voices. In January 2021, UN human rights experts warned that disabled people and older people "may feel subtly pressured to end their lives prematurely" (statement shared by Not Dead Yet). They blamed negative attitudes and "the lack of appropriate services and support." Disability groups argue that a "choice" to die is not truly free when good care, support and housing are missing.

What lawmakers did in 2026. Palliative care was central to two major national decisions this year:

• France passed two separate laws. A palliative care law, promulgated on 26 May 2026, sets out a right to palliative care for everyone whose health needs it (Dalloz). It backs a ten-year plan with about €200 million more each year until 2034, and creates new palliative care homes between home and hospital (franceinfo). The French palliative care society warned of "severe shortages" of staff. A second law, of 18 August 2026, creates a strictly limited right to aid in dying. The Constitutional Council approved it on 14 August 2026, with three reservations. Doctors must tell patients about palliative care when they assess a request (Santé.fr). As of October 2026, it cannot yet be used. Several implementing decrees are still awaited, and the government has said it aims for early 2027 (HuffPost France).
• England and Wales: On 11 September 2026, MPs voted 286 to 270 against a reintroduced assisted dying bill (BBC News). Three Labour MPs who opposed it said the country must "fix our NHS and sort out social and palliative care before we even consider introducing assisted dying." Prime Minister Andy Burnham did not vote. He has said end-of-life care funding should improve before assisted dying is considered. Supporters say they will try again, possibly as soon as next year.

These two countries took different paths. But both treated better palliative care as essential, whatever their decision on assisted dying. For the current law in every country, see our legal landscape section.

You do not need to wait for a doctor to offer it. Here are practical steps:

1. Ask for a referral. Say to your doctor or specialist: "Could I see the palliative care team?" You do not have to be dying. You can usually keep your other treatment.
2. Ask in hospital. Most large hospitals have a palliative care team. Ask the nurse in charge whether they can visit.
3. Bring your questions. For example: "What is likely to happen with my illness?" "What can be done for my pain, breathlessness or tiredness?" "Who do I call at night or at the weekend?" "What support is there for my family?"
4. Talk about what matters most. Tell your team what you hope for and what you fear. Your answer may be like Susan Block's father's: simple things that make life worth living for you.
5. Write it down. An advance directive records your wishes in case you cannot speak for yourself. Name someone you trust to speak for you. Our guide to choosing a healthcare proxy can help.
6. Ask about hospice early. If your illness is advanced, ask whether you are eligible. Remember that you can leave hospice if things change.
7. Ask about costs. A hospital or hospice social worker can explain what is covered where you live.

For a step-by-step family guide, read What Is Palliative Care? A Complete Guide for Families and 5 Signs It's Time for Hospice Care. For organisations that can help, see our resources section.

Go back to Plains, Georgia. A 98-year-old man chose to stop hospital treatment and go home. His family expected to say goodbye within days. Instead, they had almost two years. He watched baseball. He was at home with Rosalynn, his partner of 77 years, when she died. He turned 100. Hospice did not give him a cure. It gave him care, comfort and time with the people he loved, on his own terms.

Gawande put the goal in one line in Being Mortal: "Our ultimate goal, after all, is not a good death but a good life to the very end."

Not every story ends like Carter's. Some people in excellent hospice care still suffer in ways no medicine can reach. Some, in places where the law allows it, ask for assisted dying, and many of them have had palliative care too. The debate is often framed as palliative care against assisted dying. The evidence points to a harder truth. Every seriously ill person needs good palliative care, wherever they stand on that debate. And most of the world still does not have it.

Cicely Saunders wanted every dying person to know that they matter until the end. Before a crisis comes, it is worth asking yourself a few quiet questions:

• What would a good day look like for me, if I were seriously ill?
• What would I be willing to go through for more time, and what would not be worth it?
• Who would I want beside me, and do they know what I want?

Your answers will be your own. Sharing them is one of the kindest things you can do for the people who love you.