Why Do Some Ill People Want to Die?
There is but one truly serious philosophical problem and
that is suicide.
-- Albert Camus
Aug. 8, 2001 - Lost in the bitter battle over doctor-assisted
suicide is the most important question. Why do some ill people want to die? A
new look at the issue yields surprising answers.
Remarkably, these answers come not from doctors or politicians
-- they come from people facing death. The new tack taken by bioethicist James
V. Lavery, PhD, and co-workers at the University of Toronto, was to study
patients and not their doctors.
"People often referred to themselves in nonhuman terms --
'I'm just a sack of potatoes;' 'I used to be somebody but now I'm no better
than a doll,'" Lavery tells WebMD. "What people were really getting at
is that they were seeing a loss of self, a change in their fundamental nature
or essence. They saw euthanasia or assisted suicide as way of lessening this
loss of self."
"Our theory is that it is exactly in those circumstances --
and only in those circumstances -- that people desire euthanasia," he
Lavery personally held open-ended discussions with 32 people
with HIV or AIDS. Some were near death; others simply believed that they
eventually would die a terrible death. Even though it is illegal in Canada, 20
of them already had decided to seek doctor-assisted suicide or euthanasia.
Three patients had decided not to do so, and the remaining nine were
They told Lavery about their hopes and fears. They told him how
they felt about dying. They told him why they did or didn't want to die.
Two themes emerged from these stories. One was a sense of
disintegration, of falling apart. The other was loss of community -- the steady
loss of the ability to maintain close personal relationships.
"When we were listening to people's stories, they used the
same concepts -- for example, dignity," Lavery says. "They used 'loss
of dignity' to refer to losing friends, to being discriminated against, to
refer to when they couldn't control their own bodily functions any more. One
guy said, 'Once you have lost your loved ones or have been turned out, you
don't have anything anymore.'"
This loss of community appears to be a core feature of loss of
self. The finding doesn't settle the debate over whether doctor-assisted
suicide is right or wrong. It does something far more useful: It points to ways
that end-of-life care can be improved.
Robert A. Pearlman, MD, MPH, is professor of medicine at the
University of Washington and director of the Northwest Ethics Center for
Veterans Health Care, in Seattle. He is co-author of an editorial appearing
alongside the Lavery team's study in the medical journal The Lancet.
Pearlman says end-of-life care needs to address the issues of
loss of self and loss of community. He argues that healthcare research should
look for ways to help people deal with the isolation or loss of meaning that
comes from the loss of community that patients described to Lavery. Pearlman
also endorses Lavery's approach of listening to patients instead of asking