George P. Smith"s Palliative Care and End-of-Life Decisions completes a Bioethics-Health Care epistemology begun in 1989, which addresses the specific issue of managing palliative care at the end-stage of life. Smith argues forcefully that in order to palliate the whole person (encompassing physical and psychological states), an ethic of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. Specifically, this book urges wider consideration and use of terminal sedation as efficacious medical care and as a reasonable procedure in order to safeguard a "right" to a dignified death. The principle of medical futility is seen as a proper construct for implementing this process. The state legislative responses of California, Vermont, and Washington in enacting Death with Dignity legislation - allowing those with end-stage terminal illness to receive pharmacological assistance in ending their own lives - is held by Smith to be not only commendable, but the proper response for enlightened state action.