Journal of General Internal Medicine

, Volume 23, Issue 2, pp 154–157

Why Oregon Patients Request Assisted Death: Family Members’ Views

  • Linda Ganzini
  • Elizabeth R. Goy
  • Steven K. Dobscha
Original Article

Abstract

BACKGROUND

Physician assisted death (PAD) was legalized through Oregon’s Death with Dignity Act in 1994 and enacted in 1997.

OBJECTIVE

The objective of this paper was to learn from family members why their loved ones requested PAD.

DESIGN

This study used the cross-sectional survey.

PARTICIPANTS

Participants of this study included family members of 83 Oregon decedents who made explicit requests for legalized PAD before their deaths, including 52 decedents who received prescriptions for a lethal medication and 32 who died of PAD.

MEASUREMENTS

Family members rated the importance of 28 possible reasons their loved ones requested PAD on a 1–5 Likert scale, with higher scores representing greater importance.

RESULTS

According to family members, the most important reasons that their loved ones requested PAD, all with a median score of 4.5 or greater, were wanting to control the circumstances of death and die at home, and worries about loss of dignity and future losses of independence, quality of life, and self-care ability. No physical symptoms at the time of the request were rated higher than a median of 2 in importance. Worries about symptoms and experiences in the future were, in general, more important reasons than symptoms or experiences at the time of the request. According to family members, the least important reasons their loved ones requested PAD included depression, financial concerns, and poor social support.

CONCLUSIONS

Interventions that help patients maintain control, independence, and self-care in a home environment may be effective means of addressing serious requests for PAD.

Key words

physician-assisted suicide palliative care 

References

  1. 1.
    Oregon Department of Human Services. http://www.oregon.gov/DHS/ph/pas/index.shtml. Accessed 2007.
  2. 2.
    Ganzini L, Harvath TA, Jackson A, Goy E, Miller LL, Delorit MA. Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. N Engl J Med. 2002;347:582–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Ganzini L, Nelson HD, Schmidt TA, Kraemer DF, Delorit MA, Lee MA. Physicians’ experiences with the Oregon Death with Dignity Act. N Engl J Med. 2000;342:557–63.PubMedCrossRefGoogle Scholar
  4. 4.
    Ganzini L, Dobscha SK, Heintz RT, Press N. Oregon physicians’ perceptions of patients who request assisted suicide and their families. J Palliat Med. 2003;6:381–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Carlson B, Simopolous N, Goy E, Jackson A, Ganzini L. Oregon hospice chaplains’ experiences with patients requesting physician-assisted suicide. J Palliat Med. 2005;8:1160–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Compassion and Choices. Available at: http://www.compassionandchoices.org. Accessed September 7, 2007.
  7. 7.
    Ziegler SJ, Bosshard G. Role of non-governmental organisations in physician assisted suicide. BMJ. 2007;334:295–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Pearlman RA, Hsu C, Starks H, et al. Motivations for physician-assisted suicide. J Gen Intern Med. 2005;20:234–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Lavery JV, Boyle J, Dickens BM, Maclean H, Singer PA. Origins of the desire for euthanasia and assisted suicide in people with HIV-1 or AIDS: a qualitative study. Lancet. 2001;358:362–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Ganzini L, Johnston WS, McFarland BH, Tolle SW, Lee MA. Attitudes of patients with amyotrophic lateral sclerosis and their care givers toward assisted suicide. N Engl J Med. 1998;339:967–73.PubMedCrossRefGoogle Scholar
  11. 11.
    Muskin PR. The request to die. Role for a psychodynamic perspective on physician-assisted suicide. JAMA. 1998;279:323–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Vachon ML. In the terminally ill, a wish to die is a manifestation of depression and should be treated accordingly. Clin Oncol (R Coll Radiol). 2004;16:319–20.Google Scholar
  13. 13.
    Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000;284:2907–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Chochinov HM, Wilson KG, Enns M, Mowchun N, Lander S, Levitt M, Clinch JJ, Brescia R. Desire for death in the terminally ill. Am J Psychiatry. 1995;152:1185–91.PubMedGoogle Scholar
  15. 15.
    Rosenfeld B, Breitbart W, Gibson C, Kramer M, Tomarken A, Nelson C, Pessin H, Esch J, Galietta M, Garcia N, Brechtl J, Schuster M. Desire for hastened death among patients with advanced AIDS. Psychometrics. 2006;47:504–12.Google Scholar
  16. 16.
    Bharucha AJ, Pearlman RA, Back AL, Gordon J, Starks H, Hsu C. The pursuit of physician-assisted suicide: role of psychiatric factors. J Palliat Med. 2003;6:873–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Dobscha SK, Heintz RT, Press N, Ganzini L. Oregon physicians’ responses to requests for assisted suicide: a qualitative study. J Palliat Med. 2004;7:450–61.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Linda Ganzini
    • 1
    • 2
  • Elizabeth R. Goy
    • 1
    • 2
  • Steven K. Dobscha
    • 1
    • 2
  1. 1.Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Health Services Research and Development, Research Service (R&D 66)Portland VAMCPortlandUSA
  2. 2.Department of PsychiatryOregon Health & Science UniversityPortlandUSA

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