Wednesday February 17 6:40 PM ET
NEW YORK, Feb 17 (Reuters Health) -- Information gathered during the first year of legalized physician-assisted suicide in the state of Oregon shows that concerns about loss of dignity and control are the primary reasons terminally ill patients opt for physician-assisted suicide, researchers report.
"The decision to request and use a prescription for lethal medication was associated with (patient) concern about loss of autonomy and control of bodily functions, not with fear of intractable pain or concern about financial loss," write Dr. Arthur Chin and colleagues at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Their findings are published in the February 18th issue of The New England Journal of Medicine.
In October of 1997, Oregon adopted the Death with Dignity Act, becoming the first and only state to legalize physician-assisted suicide, allowing terminally ill patients to request and receive a prescription for a lethal dosage of drugs (usually barbiturates) from their doctor.
Among objections to the Act, opponents feared that poor, uneducated patients, concerned about their financial situation, might be more liable to opt for physician-assisted suicide compared with more affluent patients.
To study the effects of the Act, the CDC team interviewed doctors who
cared for the 23 terminally ill Oregon patients who requested and received
lethal prescriptions during 1998. Most of the patients (18) had terminal
cancer. According to the authors, 15 of the 23 patients died after
self-administering the prescribed drugs, 6 died from their illness, and 2 were still alive as of January 1st, 1999.
The investigators also conducted interviews with physicians caring for 43 "control" patients -- terminally ill patients who did not request physician-assisted suicide.
Chin and colleagues compared the results of the interviews and found that "the choice of physician-assisted suicide was not associated with level of education or health insurance coverage," and none of the patients in either group "expressed concern to their physicians about the financial impact of their illness."
The authors also found no differences between the two groups in terms of level of patient concern regarding uncontrolled physical pain or the notion that he or she might become a 'burden' to their families.
Instead, the motivation to request lethal prescriptions appeared to be prompted by concerns regarding a possible loss of dignity and independence. For example, patients requesting prescriptions were more than seven times as likely to "express concern about loss of autonomy" compared with control patients, according to the investigators, and more than nine times as likely to fear an eventual loss of control over bodily functions.
The researchers found that 79% of patients opting for physician-assisted suicide self-administered their lethal prescription before their illness had rendered them totally disabled. To the study authors, this finding "suggests that controlling the time of death was important to (these patients)." In contrast, all but 16% of control patients were totally disabled by the time of their death.
A patient's own personality and attitude seems to play a crucial role
in their decision to opt for physician-assisted suicide. According to the
authors, patients who opted for lethal prescription were described by their
physicians as having "been decisive and independent throughout their lives,"
sharing "a long-standing belief about the importance of controlling the
manner in which they died."
SOURCE: The New England Journal of Medicine 1999;340:577-583.
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