Most Oregonians asking for aid in dying are not depressed, study finds

In a study that will likely be cited by both sides in the debate over Initiative 1000, the Death with Dignity Act, which is on this November’s ballot in Washington State, researchers found that most Oregonians asking for lethal prescriptions to end their lives under Oregon’s 1994 law that allows physician-assisted suicide are not depressed.

But approximately one in four is depressed, the researchers write, suggesting that many patients asking for help in dying should be evaluated for depression.

In the study the researchers, interviewed 58 Oregonians with terminal illnesses who had either asked their doctors for a lethal prescription or had contacted an organization that advocates aid in dying.

Most had cancer or amyotrophic lateral sclerosis, which is also known as ALS  and as Lou Gehrig’s disease.

The lead author of the study, which appears in BMJ, the British Medical Journal, is Professor Linda Ganzini of the Department of Psychiatry at Oregon Health and Science University in Portland.

Under Oregon’s Death with Dignity Act, on which Washington’s I-1000 is modeled, a doctor can prescribe (but not administer) a lethal dose of medications to terminally ill, adult patients who are competent and choosing to end their lives voluntarily.

The Oregon law, however, requires that the prescribing physician determine that patients making the request do not have a mental disorder, such as depression, that is impairing their judgement.

However, last year, the researchers note, none of the 46 people in Oregon who died by taking the lethal prescriptions had been evaluated by a psychologist or psychiatrist. 

The Oregon researchers found that of the 58 study participants 15 fulfilled the criteria for the diagnosis of depression and 13 met the criteria for anxiety. 

Only 18 of the 58 participants actually asked for and were given prescriptions for a lethal dose of drugs.

Of these 18, only three met the criteria for depression. 

By the end of the study, of the 18 who had obtained the lethal prescriptions only nine had used them to end their lives.

Three of those nine were the patients who had met the criteria for depression.

The researchers conclude that while “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.”

The BMJ article is accompanied by a editorial written by Marije L van der Lee, health of the scientific research department of the Helen Dowling Institute in the Netherlands, a country where both physcian-assiseted suicide and actual euthanasia, where the doctor actually administers the lethal drugs, are legal.

Van der Lee notes that in most cases euthanasia usually shortens a dying patient’s life by less than one month. This is too short a time to treat depression, and, so it is likely the patient would die of their terminal illness before their depression had responded to treatment.

It would be bette, therefor, writes Van der Lee, to screen terminally ill patients earlier so that their depression can be treated and their psychological suffering reduced. 

“Given that a quarter of terminally ill patients with cancer have depressive disorders,” Van der Lee writes, “screening all terminally ill patients systematically seems advisable, rather than screening only the minority of patients seeking legalized assistance in dying.”

To learn more:

• Read the article and editorial in the BMJ (subscription or fee required).
• Read Ostrom’s recent articles on I-1000 in the Seattle Times.
  • How we die: a vote that transends politics
  • Doctors divided on assisted suicide
• Visit the websites of the proponents and the opponents.
  • Proponents—Yes! on I-1000: www.yeson1000.org
  • Opponents—Coalition Against Assisted Suicide: www.noassistedsuicide.com
• Read the official ballot measure summary below or the full text of initiative-1000.

Official Ballot Measure Summary:

This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months, to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity.

Tags: Aid in Dying, Assisted Suicide, Death with Dignity, Physician-assisted Suicide

Category: End-of-Life Care, Ethics, Health-care Policy, Palliative Care, Uncategorized