Hot off the press, first from an article from today’s US News & World Report, carefully titled “Oregon’s Assisted Suicide Law May Overlook Depressed Patients“:
WEDNESDAY, Oct. 8 (HealthDay News) — Oregon’s physician-assisted suicide law may not adequately protect the one in four terminally ill patients with clinical depression, a new study says.
The Death with Dignity Act was passed by the state in 1997, and there’s been intense debate about the extent to which potentially treatable psychiatric disorders may influence a patient’s decision to hasten death, according to a news release about the study, published online Oct. 8 by the British Medical Journal.
The act does contain several safeguards to ensure patients are competent to make the decision to end their life, including referral to a psychologist or psychiatrist, if there’s concern that a mental illness may be impairing a patient’s judgment. However, depression is often overlooked in mentally ill patients.
In 2007, none of the 46 people in Oregon who used physician-assisted suicide were evaluated by a psychologist or psychiatrist, the news release said.
For the new study, researchers at Oregon Health and Sciences University checked for depression or anxiety in 58 terminally ill patients who’d requested physician-assisted suicide or had contacted an assisted death organization. Fifteen of the patients met the criteria for depression and 13 for anxiety.
By the end of the study, 42 patients had died. Of those, 18 received a prescription for a lethal medication, and nine died by lethal ingestion. Of those who received a prescription for a lethal medication, three met the criteria for depression. All three died by lethal ingestion within two months of being assessed by researchers.
Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.
This is a very restrained conclusion. A closer look at the data in the paper reveals that levels of anxiety and depression were reported in an even larger number of participants, even if the levels didn’t reach the standard for clinical depression.
Given the larger context, namely that no one obtaining a lethal prescription in 2007 was referred to a psychologist or psychiatrist, it’s fair to question just how much care and support these individuals are given when thinking about suicide.
The study authors also note that “in 2006 Compassion and Choices gave information to or attended the deaths of three quarters of patients who choose aid in dying.” I’m going to take a leap here and assume that Compassion and Choices has its own list of doctors it sends people to – doctors who don’t tend to be too concerned about giving patients any kind of support other than a lethal prescription. (i.e. Could anxiety and depression be reduced in these individuals, making them less likely to want to kill themselves? Do the doctors care?)
Predictably, Compassion and Choices has already come out and put its “spin” on the study.
On the left side of its main page, under “top stories” is the headline:
“10.7.2008 New Study: All Patients Using Oregon Death with Dignity Act Were Mentally Competent to Make Informed Choice.”
The “spin” in the comments on the Compassion and Choices website is provided by two medical professionals with a long history of advocating euthanasia and assisted suicide. Compare their comments against the article in the BMJ.
I find it curious that this study was published in the BMJ rather than an American publication. I don’t know what – if anything – to make of that. –Stephen Drake
Clinically depressed people are just a fraction of those who are vulnerable to assisted suicide. Ask anyone who has survived a very serious illness the question as to whether they seriously contemplated suicide at their “lowest” point. Now ask them if they wish someone had assisted them in doing so. I doubt you will get many “yes” answers to the 2nd question.
The whole notion of “consent” is seriously naive when it comes to people who are facing debilitating illnesses or living with debilitating conditions.
I have to ask those who favor assisted suicide a very blunt question. What do you, I, the patient, or society gain by offering to assist someone in *any* circumstance with killing himself/herself? After all, if someone is seriously motivated to do this, they do not need the help (except in rare cases) of a doctor or third party to accomplish this goal. The assistance by a third party serves only to overcome the natural instinctual barrier we all have to suicide. This barrier is healthy and we have no interest in lowering it.
This whole notion that people need the assistance of third parties to take their own life is dubious. None of us has any interest in providing moral, financial, or physical assistance in helping someone take their own life. This appears to be one of those really bad ideas whose time has come. The motivation for this concept is much more similar to animal euthanasia than we are all willing to acknowledge. After all, despite the compassion we feel for our pets and the desire to spare them pain and suffering, we could choose to spend massive amount of time and money to keep them alive and comfortable for most of the reasons we euthanize them. We don’t do this because we deem this effort and expense to not be appropriate for animals.
Despite all the handwringing and platitudes by advocates of assisted suicide for humans, we are really saying the same things for humans when we prattle on about “right to die” and “death with dignity”. People are different than my beagle and I want to live in a society that treats them differently.
The results of this study are so disturbing-something should be done immediately.
kara,
there is an immediate response – unfortunately the most immediate response is that the assisted suicide advocates are spinning the study as a “success” story for Oregon.
roger,
thanks for your comments. I agree fully with your assessment on the different importance we put on our pets versus our human loved ones. At some point, I expect I’ll be quoting your comment on this in a blog entry. –Stephen
To my knowledge, advocates of suicide “choice” bolster their numbers of mentally healthy suicide “choosers” in a very simple but slick, slick way.
Because they believe suicide is a “rational” response to being sick or disabled, they redefine the diagnostic criteria for depression and other psychiatric conditions to suit their ends. They drop suicidality from the list of clinical symptoms.
And so they automatically block out a whole lot of things they really, really don’t want to deal with. It’s no surprise, that, whoops! the safety guidelines for “chosen” death in Oregon haven’t actually protected people.
It’s always easier for the Powers That Be to slickly push for “rational” killing instead of facing the expensive and complex challenges of not simply diagnosing and treating depression, ptsd, and other psychiatric disabilities, but dismantling the oppression that so often stresses human beings to the point of mental illness and suicide.