Need for Control Drives Assisted Suicide Requests: Patients Who Went through with Assisted Suicide Wanted to Be Self-Reliant until the End, Studies Show
MacNeil, Jane Salodof, Clinical Psychiatry News
SANTA ANA PUEBLO, N.M. -- The key factor motivating the terminally ill to seek assisted suicide under Oregon's Death with Dignity Act--a sense of control--should prompt a rethinking of end-of-life care, Dr. Linda Ganzini said at the annual meeting of the Academy of Psychosomatic Medicine.
Studies of terminally ill patients in Oregon showed that "some people want to leave this world in the driver's seat. That's their major goal," said Dr. Ganzini, director of the geriatric psychiatry fellowship program at Oregon Health and Science University, Portland. 'And we need to let this goal start driving how they should be cared for--whether they get assisted suicide or not."
The findings gained new currency last month, when the U.S. Supreme Court ruled that the Bush administration improperly tried to use a federal drug law to stop physicians from prescribing lethal drugs to terminally ill patients under the Oregon law.
The studies, which also included physicians, nurses, hospice chaplains, and family members, showed that few of the factors anticipated in the political debate over the law were significant to the terminally ill in determining who chose assisted suicide. Most patients who requested lethal prescriptions were no more depressed, poor, poorly educated, from minority groups, or in worse physical condition than were those who opted not to make such a request.
"These were individuals who wanted to control their lives," Dr. Ganzini said. Relatively few people go through with assisted suicide, but those who do are determined to remain self-reliant until the end.
Often, those who requested assisted suicide had highly successful careers and worked as school superintendents, teachers, lawyers, and dentists, Dr. Ganzini said. Overcoming adversity early in life was another common experience for many who requested assisted suicide.
"Many had parents who were neglectful or incompetent," she said. "They learned to be very self-sufficient and to prize their independence."
Oregon's voters passed its Death with Dignity Act by a slim majority in 1994, making Oregon the first and only state to approve assisted suicide. The act was delayed by a legal injunction until 1997, when 60% of voters refused to repeal it.
Since 1997, Oregon has had 208 deaths by assisted suicide, said Dr. Ganzini, also a senior scholar at the university's center for ethics in health care. "For every 1,000 patients in Oregon who die, 100 will seriously consider assisted suicide, 10 will make an explicit request, and 1 will die by it," she said.
Amyotrophic lateral sclerosis (ALS) is the disease tied to the highest number of assisted suicide requests, Dr. Ganzini said. Compared with other patients, ALS patients in Oregon have an odds ratio above 20 for dying by assisted suicide.
A study she and her associates conducted with 100 ALS patients showed that a sense of hopelessness was an important predictor of interest in obtaining a lethal prescription.
Dr. Ganzini is now studying patients who are in the process of making legal requests. "They are really focused on what is coming down the road, how intolerable it will be, and how it will make their lives not worth living when it happens," she said. …