中国大学MOOC: Which of the following may hinder goodwill and communicate ineffectively?

For active euthanasia in Japan, four conditions must be met: A: The patient must be suffering from unbearable physical pain. B: Death must be inevitable and drawing near. C: The patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.) D: The physician must have (ineffectively) exhausted all other measures of pain relief.