Thursday, February 16, 2006

Physician study on Death with Dignity Act

The New England Journal of Medicine was the first to report on physician experiences with requests for assisted suicide under the Oregon Death with Dignity Act. Since the legislation was enacted in November 1997, physicians have honored 1 in 6 requests, and of these, 1 in 10 actually resulted in suicide.

"We found that Oregon physicians are responding in a careful and prudent manner when patients request assisted suicide," said first author Linda Ganzini, MD, director of geriatric psychiatry at the Portland Veterans Affairs Medical Center and associate professor of psychiatry at Oregon Health Sciences University. "Our data support that the first response of a physician who receives a request is to look for treatable physical and psychological symptoms. Only a small proportion of patients who request lethal prescriptions actually receive and die by them."

Nearly half of physicians receiving requests ended up providing alternative "palliative" care, such as pain control and/or referral to Hospice. Forty-six percent of patients who received these palliative interventions changed their mind about assisted suicide.

The survey also showed that patients who completed suicide were already receiving substantial palliative care, and 81% were in hospice care. This supports the assumption that the majority patients who actually died by suicide were already utilizing all available means to maximize their quality of life.

The researchers of the study received information on 165 people requesting lethal prescriptions. The most common diagnosis was cancer. The most common reasons for pursuing assisted suicide were concern about loss of independence (57%), poor quality of life (55%), readiness to die (54%), and desire to control the circumstances of death (53%). Physical suffering was common ranking pain (43%), shortness of breath (27%), and fatigue (31%) of the totals.

The authors of the study showed that contrary to some concerns, the demographics of patients requesting lethal prescriptions matched those of people in the general population who died during the same period. Vulnerable groups, such as women, ethnic minorities, and people without health insurance, were not overrepresented.

The study did show that eleven percent of patients requesting lethal prescriptions were concerned that they were a financial drain on others, 6% lacked social support, and 2% had no medical insurance. Although 38% perceived themselves as a burden to others, physicians were unlikely to honor requests from these patients.

Physicians reported that 20% of requesting patients had symptoms of depression, but none of these received a lethal prescription. Many physicians reported they had made efforts to improve their knowledge of depression and psychiatric symptoms also had made substantial efforts to improve their knowledge and use of pain control, and other appropriate palliative care.

This study was somewhat revealing because it did not support some of the fears that critics maintained. A follow-up study should be done because as with most things, once they become common-place, we lose our objectivity and our moral reasoning with them. This would have the potential to lead to future abuses.

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