According to a study published on bmj.com, Oregon’s Death with Dignity Act may not be adequately protecting the 25% of terminally ill patients in the State of Oregon who have depression and then choose physician assisted suicide. The Death with Dignity Act was passed in Oregon in 1997 and allows physician-assisted dying for terminally ill patients
There has been, and continues to be, a considerable amount of debate concerning physician-assisted death. It is possible, argue some, that potentially treatable psychiatric disorders may influence a patient’s choice between life and death. Although the Act contains safeguards that are designed to make sure patients are competent enough to make life-ending decisions – such as referrals to a psychologist or psychiatrist – health care professionals often miss depression in mentally ill patients who may have impaired judgment. None of the 46 Oregonians who died by lethal ingestion in 2007 were evaluated by a psychiatrist or a psychologist.
To further study the relationship between physician-assisted suicide and depression, Dr Linda Ganzini (Oregon Health and Science University) and colleagues conducted a study consisting of 58 terminally ill Oregonians. All patients had requested physician assisted suicide or had contacted an aid in dying organization, and the researchers sought to determine if they had depression or anxiety. The depression and anxiety assessment utilized standardized measures, questionnaires, and interviews.
The researchers conclude that Oregon’s current system of physician-assisted suicide resulted in lethal prescriptions given to some clinically depressed patients – some who were potentially ineligible to participate.
Of the total, 15 patients were considered depressed and 13 had anxiety. By the end of the study, 42 patients had died, 18 received a prescription for a lethal medication under the Act, and nine died by lethal ingestion. Although 15 patients who received a lethal prescription did not meet the criteria for depression, three did meet the criteria and then died by lethal ingestion less than two months after the research interview.
The researchers realize that the majority of patients who request dying aid do not meet the criteria for depression. However, they write that, “The current practice of Death with Dignity Act may not adequately protect all mentally ill patients.”
They conclude: “Increased vigilance and systematic examination for depression among patients who may access legalised aid in dying.”
Dr Marije van der Lee (Helen Dowling Institute in the Netherlands) writes in an accompanying editorial about the complexity inherent in determining whether or not terminally ill patients have impaired judgment due to depression. She argues that depression does not necessarily impair judgment. What is most important, at least in her native Netherlands, is whether or not the patient makes in informed decision. “We should focus on trying to ‘protect’ patients from becoming depressed in the first place, rather than focus on protecting patients from assisted suicide,” she concludes.
Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey
Linda Ganzini, Elizabeth R Goy, Steven K Dobscha
BMJ (2008); 337:a1682
doi:10.1136/bmj.a1682
Click Here To View Journal Website
Written by: Peter M Crosta