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End-of-life care has received increasing attention in recent years. The pioneering studies of Elisabeth Kübler-Ross on death and dying, begun in the the 1960s, have afforded valuable insights into the evolving emotions, experiences, and needs of the dying person. Health care professionals have formally recognized the importance of rendering humane and competent care at the end of life in ways that preserve the dignity and autonomy of the patient. Physicians, particularly oncologists, who treat patients with terminal illness have focused on the need to distinguish clearly between aggressive and palliative forms of treatment and to establish guidelines for the care of patients for whom further cure-oriented treatment will be of no benefit. In particular, they have recognized the importance of providing adequate pain relief to patients with advanced cancer. Increased attention has also been given to the control of fatigue, anorexia, cachexia, nausea, vomiting, and dyspnea, which often occur in terminal illness. Studies have shown that pain relief in terminal patients is often inadequate because physicians are afraid of inducing narcotic addiction or of being accused of hastening death. Wider use of opioid analgesics and development of patient-controlled analgesia and anesthesia systems have improved control of pain in terminal cancer and AIDS. Professional nurses have embraced the obligation to provide relief of suffering, comfort, companionship, and, when possible, a death that is congruent with the dying person's wishes. The hospice movement has established programs and facilities within the organized health care system that focus on the special needs of dying patients for comfort and care rather than efforts at cure. These programs include support of caregivers and family members during and after the patients' final illness. There is general ethical consensus that the withholding or withdrawal of life-sustaining treatments in terminal illness is not euthanasia but rather a decision to allow the disease to follow its natural course. End-of-life care emphasizes the importance of frank, timely, supportive discussion of such matters as preferences for life-extending care, including cardiopulmonary resuscitation, mechanical ventilation, artificial hydration and nutrition, renal dialysis, and surgery before decisions about the use of such measures become necessary. Legislatures have sought to preserve the dignity and independence of people nearing the end of life by allowing them to enact advance directives for their care in the event that they become incompetent or comatose. The integrity of the relationship between patients and health professionals has been threatened by growing social and legal toleration of physician-assisted suicide. The American Medical Association and the American Nurses Association have issued official position statements opposing assisted suicide. see also advance directive, physician-assisted suicide, living will.