Aug 22, 2002
In a study of Oregon nurses and social workers who care for hospice patients, control issues were among the most important reasons why patients requested physician-assisted suicide, according to a new report.
In contrast, depression, lack of social support, and fear of draining the family's financial resources were among the least important reasons given, lead author Dr. Linda Ganzini, from the Portland VA Medical Center in Oregon, and colleagues note.
With the passing of the Death with Dignity Act in 1997, physician-assisted suicide became legal in Oregon. From 1998 to 2001, 91 individuals died by assisted suicide.
Because 78% of the 91 people who died were hospice patients, Dr. Ganzini's team decided to survey hospice nurses and social workers about the reasons why such patients requested physician-assisted suicide. Based on conversations with the patient or family, the subjects were asked to rate the relative importance several reasons played in the suicide decision.
The researchers' findings are published in the August 22nd issue of The New England Journal of Medicine.
Of 545 eligible nurses and social workers, 397 (73%) returned the mail survey. Since November 1997, almost half of the respondents had cared for at least one hospice resident who requested assisted suicide, the authors note.
Eighty-two patients had received prescriptions for lethal medications from 1997 to 2001, the report indicates. Nearly all of the nurses who were presented with a suicide request discussed it with a coworker and 77% of the requests were discussed at an interdisciplinary conference.
Reasons rated as very important for seeking assisted suicide included a desire to control the circumstances of death, a readiness for death, and a desire to die at home, the authors note. A fear of burdening others was rated as somewhat important, but only 11% of respondents reported that family caregivers of suicide-requesting patients were more burdened than caregivers of other hospice residents.
"Patients make the choice to request assisted suicide because they want to control the timing and manner of their death," Dr. Ganzini said in an Oregon Health and Science University statement. "It's surprising how we found so little variation with regard to this characteristic, almost as if the nurses and social workers were all seeing the same patient."
The findings suggest that hospice programs act as safeguards for physician-assisted suicide "by increasing opportunities to find alternatives, and ensuring that patients have adequate decision-making capacity, aren't depressed and aren't acting impulsively," Dr. Ganzini noted.
N Engl J Med 2002;347:582-588.
© 2002 Reuters Ltd