ASSISTED SUICIDE I: Hopelessness Is Key Motivation

      A survey of terminally ill Washington and Oregon residents finds that a majority were willing to consider physician-assisted suicide. Published in today's New England Journal of Medicine, the survey is based on interviews with 100 patients, all of whom were diagnosed with amyotrophic lateral sclerosis (ALS). Fifty-six percent of the patients agreed with the statement, "Under some circumstances I would consider taking a prescription for a medicine whose sole purpose was to end my life." In addition, 44% "said they would request a prescription for a lethal does of medication from a physician if it became a legal option." The study took place before Oregon's assisted suicide law took effect. The patients willing to consider suicide "were more likely to be men, had more years of education, had higher scores for hopelessness, were less likely to be religious (on all measures), and rated their quality of life as lower than those who disagreed with the statement." The survey authors found "no difference in the prevalence of depression between the patients" who would consider suicide and those who would not. The patients' caregivers were also surveyed, and the researchers found that 62% of the caregivers "said they would support the patient's decision to take a lethal dose of medication."

Fight The Hopelessness
      The researchers note that opponents of assisted suicide have raised the "concern that poor persons would be more likely to choose physician-assisted suicide if it were legalized." However, the survey of ALS patients "found that persons with higher socioeconomic status (as measured by educational level) were more likely to desire this option." Noting that hopelessness was a key factor motivating patients to desire assisted suicide, the researchers suggest interventions: "Our study suggests that where physician-assisted suicide is legal, some terminally ill patients may request a prescription for a lethal dose of medication well before they intend to take it. Such requests may be prompted more by pessimism about the future than by current suffering. Physicians may be able to help patients by exploring their feelings of dread and enhancing their sense of control." The survey was conducted by researchers at the Oregon Health Sciences University, the Portland Veterans Affairs Medical Center and Providence ElderPlace (Ganzini et al, 10/1 issue).

Important Questions
      In an accompanying editorial, Columbia-Presbyterian Medical Center's Dr. Lewis Rowland notes "several problems" raised by the ALS patients' willingness to choose assisted suicide:

• First, he notes that patients must choose a date for their suicide, but "[t]here are no guidelines for this decision, and it is difficult to imagine any that would help identify a time that was neither too soon nor too late."
• Second, Rowland points out that Oregon's Death with Dignity Act prohibits lethal injection. ALS patients "who live long enough will lose the use of their hands," eliminating their ability to take a lethal prescription on their own. Thus, these patients would require someone else to administer the drugs -- "But that would be euthanasia, not assisted suicide, and we would be on the slippery slope feared by critics of physician-assisted suicide."
• Third, he notes that "the public, the courts, and much of the medical community have had difficulty separating refusal or discontinuation of therapy, both of which are legally accepted, from assisted suicide and euthanasia." He argues that the "distinction between assisted suicide and euthanasia may be the most controversial issue of all" (10/1 issue).