Hospice is the best-known example of palliative care. Advocates maintain that good palliative care precludes any need for suicide, assisted suicide, or euthanasia for suffering patients near the end of life. This article examines the feasibility of the palliative approach for all patients, showing that reasonable people may refuse even the most exemplary care for themselves or an incompetent relative. Palliative care should always have an important place in medicine. Yet medical realities and the alleviation of pointless suffering necessitate that policymakers consider other options, including “active” euthanasia, consistent with patient autonomy and the right to die.