Why do patients request physician-assisted death (a.k.a. physician-assisted suicide)?
General Reference (not clearly pro or con)
Robert Pearlman, MD, MPH, Professor of Medicine at the Departments of Medicine, Medical History and Ethics, and Health Services, University of Washington, and Helene Starks, MPH, PhD, Assistant Professor in the Department of Medical History and Ethics at the University of Washington, Seattle, wrote in their chapter "Why Do People Seek Physician-Assisted Death?" that appeared in the 2004 book Physician-Assisted Dying: The Case for Palliative Care and Patient Choice:
"Popular explanations for physician-assisted death include inadequate treatment for pain or other symptoms, depression, hopelessness, and socioeconomic stressors, such as concerns about the burden of increasing dependency on other members of the family and the economic hardship associated with the costs of health care...
In our interviews with thirty-five families, we asked questions about the history of the patient's illness, the patient's stated reasons for seeking aid in dying, and other factors influencing the pursuit of physician-assisted death, as well as the manner of death. Our analysis identified nine common factors. No single factor on its own ever accounted for a serious interest in a hastened death. Rather, interest usually arose out of an interactive process involving multiple factors in three broad categories...
Feeling weak, tired, and uncomfortable 24 (69%)
Loss of function 23 (66%)
Pain or unacceptable side effects of pain medication 14 (40%)
Threats to sense of self
Loss of sense of self 22 (63%)
Desire for control 21 (60%)
Long-standing beliefs in favor of hastened death 5 (14%)
Fears about the future
Fears about future quality of life and dying 21 (60%)
Linda Ganzini, MD, MPH, Professor of Psychiatry and Medicine Senior Scholar at the Center for Ethics in Health Care, Oregon Health & Science University, Theresa Harvath, PhD, RN, Associate Professor at the Oregon Health & Science University School of Nursing, Portland, Ann Jackson, MBA, Executive Director and CEO of the Oregon Hospice Association, et al. wrote in their Aug. 22, 2002 article, "Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide," that appeared in the New England Journal of Medicine:
"According to the hospice nurses, the most important reasons for requesting assistance with suicide, among patients who received prescriptions for lethal medications, were a desire to control the circumstances of death, a desire to die at home, the belief that continuing to live was pointless, and being ready to die. Depression and other psychiatric disorders, lack of social support, and concern about being a financial drain were, according to nurses, relatively unimportant. Seventy-seven percent of the nurses reported that patients who received prescriptions for lethal medications were more fearful of loss of control over the circumstances of death than were other hospice patients, whereas 8 percent reported that such patients were less fearful than other hospice patients. Sixty-two percent of the nurses said that patients who received prescriptions for lethal medications were more likely to be concerned about loss of independence than were other hospice patients, whereas 9 percent said that such patients were less concerned about loss of independence than were other hospice patients.
Hospice social workers reported that the desire to control the circumstances of death, the wish to die at home, loss of independence or fear of such loss, and loss of dignity or fear of such loss were the most important reasons for requesting prescriptions for lethal medications; the median score for all these reasons was 5 on the 1-to-5 scale. They ranked lack of social support and depression as the least important reasons; the median score for both was 1…
Many of the nurses reported that pain or fear of pain was an important reason for the request for assistance with suicide. Only 15 percent of the nurses, however, reported that the patient had more pain, on average, than other hospice patients, whereas 42 percent reported that the patient had less pain, on average, than other hospice patients. Other physical symptoms, such as fatigue and dyspnea, were reported to be only moderately important reasons for the request, and 58 percent of the nurses reported that the patients who received prescriptions for lethal medications had less dyspnea than other hospice patients."
The Oregon Department of Human Services explained in its Mar. 9, 2006 "Eighth Annual Report on Oregon's Death with Dignity Act":
"In this eighth annual report, we characterize the 38 Oregonians who died in 2005 following ingestion of medications prescribed under provisions of the Act, and look at whether the numbers and characteristics of these patients differ from those who used PAS in prior years…
Providers were asked if, based on discussions with patients, any of seven end-of-life concerns might have contributed to the patients' requests for lethal medication. In nearly all cases, physicians reported multiple concerns contributing to the request. The most frequently reported concerns included a decreasing ability to participate in activities that make life enjoyable (89%), loss of dignity (89%), and losing autonomy (79%)…
Physicians have consistently reported that concerns about loss of autonomy, loss of dignity, and decreased ability to participate in activities that make life enjoyable as important motivating factors in patient requests for lethal medication across all eight years. Interviews with family members during 1999 corroborated physician reports. These findings were supported by a study of hospice nurses and social workers caring for PAS patients in Oregon."