For Most Patients, a Good Death Is Dying Naturally
Nov. 14, 2000 (Washington) -- Many patients support physician-assisted suicide, but few seriously consider it for themselves, even when they are terminally ill, according to a new report released Tuesday. The report also shows that those patients who are interested in assisted suicide are more likely to be suffering from psychological rather than physical pain.
The first-of-its-kind study, available in The Journal of the American Medical Association, relied on interviews with nearly 1,000 terminally ill adults and their caregivers. Two to 6 months later, the surviving patients were interviewed a second time; for the 256 patients who had died, their caregivers were interviewed.
Although 60% of the terminally ill patients said they supported physician-assisted suicide in a hypothetical situation, only about 10% reported that they seriously considered ending their life with that option. African-Americans and religious individuals were more likely than others to oppose assisted suicide.
Of the 256 patients who died, fewer than 6% had discussed physician-assisted suicide with their caregiver, and fewer than 3% had actually hoarded drugs for possible suicide. And only one of the patients who died did so through assisted suicide.
"By and large, euthanasia and assisted suicide are irrelevant or secondary to end-of-life care. There're not going to be a primary factor," the study's lead author, Ezekiel Emanuel, MD, PhD, tells WebMD. He is chief of clinical bioethics at the National Institutes of Health.
"The whole country's been obsessed by [assisted suicide], but it is a sideshow," Emanuel tells WebMD. Congress may send legislation to the White House next month to outlaw Oregon's first-in-the-nation law that permits physician-assisted suicide. President Clinton has expressed concern that the bill would deter doctors from taking aggressive steps to control pain among the terminally ill. Emanuel declined to comment on the legislation.
Emanuel will say that Americans are "over-obsessed" with pain control as part of end-of-life care. But what is really important to dying patients? "Resolution, spiritual issues, depression. ... I wouldn't say 'I treated the pain; therefore, I had a good death.' That's clearly an oversimplification." Only one of the first 15 patients who died under Oregon's assisted suicide law suffered from pain, he notes.
A separate survey in The Journal of the American Medical Association on what makes a "good death" found broad agreement among patients, families, doctors, and other care providers that pain control is the most important aspect of a "good death."
Nonetheless, with depression linked more strongly to patients' interest in assisted suicide than pain, Emanuel emphasizes that doctors need to better recognize and treat depression among the terminally ill. Feeling unappreciated and needing significant help with basic daily activities were two other factors that caused patients to consider suicide.
Emanuel points out, however, that patients' views on assisted suicide were unstable in general. In his study, half of those who initially considered suicide later changed their minds, and follow-up interviews with other patients revealed support for assisted suicide where there had been none earlier.