Patients on their deathbeds should be given more pain relievers even if the drugs hasten death, researchers at a Toronto-based medical ethics think-tank argue in a study released in March 2003.

The researchers said their recommendations clarify the blurry lines between euthanasia, which is illegal in all countries expect the Netherlands, and good medical care for dying people who are in pain.

The study's guidelines could spark controversy with groups opposed to euthanasia who say they're concerned that doctors might take the recommendations of the study too loosely.

"What we're trying to address is that one of the fundamental reasons why people die in pain is because physicians are afraid to provide appropriate pain relief because they are are afraid of crossing that line between palliative care and euthanasia," said Peter Singer, director of the University of Toronto Joint Centre for Bioethics.

"No one should die in pain," Dr. Singer told Reuters.

The study, based on a panel that included intensive care doctors and the deputy chief coroners of five Canadian provinces, is published in a peer reviewed Internet journal called BMC Medical Ethics.

The authors hope their recommendations will be adopted by critical care societies, hospitals and coroners.

"We want doctors to feel comfortable that they can give drugs without being misinterpreted," said Laura Hawryluck, assistant professor of medicine and critical care at the University of Toronto, who also was part of the study.

"There have been cases of euthanasia in Canada and coroners may be concerned about the administration of high doses of opiates and whether the intent was to kill or to palliate," she said.

Dr. Singer said "folklore is that treating the pain hastens death. That is what most people believe. Some of the early evidence now is showing that untreated pain itself hastens death more than the treatment of such pain."

Joanne Lynn, director of the Home Center for Palliative Care Studies in Washington, D.C., said she agrees with the recommendations.

"Anybody who does not want to back this should themselves have to live through it or die that way," said Dr. Lynn, who is also president of Americans for Better Care of the Dying.

"This is a good idea and knowing the work that the Toronto group does, I'm sure it is thoughtfully and carefully argued."

Dr. Hawryluck said the researchers do not advocate euthanasia.

"We're trying to address this fuzziness about what is euthanasia and what is good palliative care. ... The one thing that people who are for, and who are against, euthanasia can agree on is that people should not die in pain."

But Karen Murawsky, a spokeswoman for Campaign Life Coalition, an Ottawa-based group that opposes euthanasia, said she was worried that doctors might take the recommendations too loosely.

"It should not be done without a conference of family and patient and doctor. We do not think there should be laws in the books where a doctor can say, 'What can I get away with?'" says Ms. Murawsky.

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