Depression and Euthanasia
In the November 15, 2000 Journal of the American Medical Association, a special issue dedicated to end-of-life care, Drs. Linda and Ezekiel Emanuel and Diane Fairclough report on a survey of 988 terminally ill patients receiving care in five cities and one rural county in the U.S. Some of their findings:
* 60.2% of the patients supported euthanasia or physician-assisted suicide (PAS) in a hypothetical situation of unremitting pain, but only 10.6% had seriously considered such things for themselves.
* While a majority supported euthanasia or PAS in a case of unremitting pain, "less than a third support it when the patient desires it because of fear of being a burden on the family." {Ironically, 63% of the patients receiving assisted suicide in Oregon last year were motivated by fear of being a burden on others, while only 30% cited unrelieved pain as a consideration)
* Those most likely to consider euthanasia or PAS for themselves were those who had depressive symptoms, substantial caregiving needs, and pain. Those least likely to consider it were those who felt appreciated, were 65 years old or older, were African American, or were religious.
* At a follow-up interview, half the patients who had considered euthanasia or PAS for themselves had changed their minds, while an almost equal number of patients had begun considering these interventions, especially those who had developed depressive symptoms or dyspnea.
* Of the 256 patients who died during the study, only one (0.4%) died by euthanasia or assisted suicide, one unsuccessfully attempted suicide, and one repeatedly asked to have her life ended but family and physicians refused.
* The authors note "a tension between attitudes and practices, between the reason people find euthanasia and PAS acceptable - predominantly pain - and the main factor motivating interest in euthanasia or PAS - patient depression." They propose that physicians who are asked to perform euthanasia or PAS "should attend to the possibility of depression and other psychological stressors." [E. Emanuel, L. Emanuel, and D. Fairclough, "Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers," 284 JAMA 2460-68 (Nov. 15, 2000)].
Confirming the central role of mental illness in suicides among the sick and elderly, a psychiatrist's recent overview of suicide prevention in primary care discounts the notion that physical illness is somehow a sufficient cause for suicides in the elderly. "Indeed," he notes, "there is considerable evidence to indicate that comorbid psychopathologic conditions play a large role in suicides among the elderly" [N. Gregory Hamilton, "Suicide prevention in primary care," 108 Postgraduate Medicine 81-7 (Nov. 2000)].
It's likely that continued study of the link between depression and euthanasia will produce more accurate information uponS which more accurate judgments can be based.
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