TERMINALLY ILL: Depression Biggest Factor In Suicide
The chief reasons terminally ill patients consider euthanasia or assisted suicide are depression and dependence on others, according to a "landmark study of nearly 1,000 dying patients" presented this week at a Los Angeles meeting of oncologists. The Boston Globe reports that the findings run counter to the common belief that pain is the leading reason people consider suicide, "carry[ing] large implications for caregivers, patients and families, as well as for health care policy." The study's lead author, National Institutes of Health Chief Ethicist Dr. Ezekiel Emanuel, said: "When the American public thinks that euthanasia or physician-assisted suicide is acceptable, they are imagining a patient in uncontrollable agony. Few people think it is justifiable to end the life of a patient because he or she is depressed or needs a lot of help with eating or changing bandages or cleaning the house."
The Depression Factor
The study found that "severely depressed" terminally ill patients are twice as likely to consider suicide as terminally ill patients in general. Specifically, 20% of terminally ill patients "depressed all or most of the time" said they had contemplated suicide. And 16% of terminally ill patients with "heavy care needs" said they had "seriously" considered suicide. Ten percent of those patients with "little or no such dependency on others" said they had considered suicide. Only 4% of terminally ill patients who were not depressed said they had considered ending their life. The study does show, however, that only a minority, or 10.5% of all terminally ill patients seriously contemplate suicide.
Experts at the conference warned that reductions in Medicare payments have driven many patients to "despair." Emanuel "said patients' fear of becoming a burden on others should be seen in light of an imminent federal clamp-down on escalating home health care expenditures." Geriatrician Michael Cantor said, "I already see patients whose biggest fear is that they will become a burden on their families. And that's before new government policies on home care reimbursement take effect." Emanuel said the U.S. has "a contradictory social policy. The government is worried about home care fraud, but we need to be sure that people get the services they need without enormous economic burdens" (Knox, 5/20).