Kathleen M. Foley, MD

The use of sequential therapeutictrials to determine the optimaldrug for a given patienthas become a standard strategy in painmanagement. We appreciate Estfanand colleagues’ thoughtful and practicalreview of the advantages and disadvantagesof opioid rotation in cancerpain management.[1] Their commentson the need for individualization ofopioid dose and ongoing monitoring,opioid choice in renal and liver insufficiency,compliance, and cost reductionare particularly important.

Over the past decade, increased attention has focused on the care of dying patients. The role of the physician in caring for these patients has been the subject of renewed interest and intense, sometimes passionate, debate. Patient groups have formed to advocate for the promotion of compassion in the care of the dying, and some of these advocacy groups have asserted a fundamental “right” to physician-assisted suicide. The US Supreme Court has ruled against a constitutional right to physician-assisted suicide but has asserted its willingness to reconsider the issue if it learned that dying patients were not receiving appropriate, high-quality end-of-life care.[1]