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Study criticizes Oregon's Death with Dignity Act

October 8, 2008 |  1:00 pm

Suicide1 One in four terminally ill patients in Oregon who opt for physician-assisted suicide have clinical depression and may not be capable of making an informed, rational decision about ending their lives, according to a provocative study published today in the British Medical Journal.

Eleven years ago, Oregon became the first state to enact a law allowing for physician-assisted suicide. The Death with Dignity Act permits terminally ill patients to kill themselves with a lethal dose of medications prescribed by their doctors for that specific purpose. Much debate has centered on the issue of whether the law protects patients who may be pressured by family members to end their lives or whose judgment is impaired by physical or mental illness.

The study by researchers at Oregon Health and Science University examined 58 Oregon residents who requested physician-assisted suicide or contacted an aid-in-dying organization. The authors used standard measures and interviews with patients to assess their mental states. They found that 25% of the patients could be defined as clinically depressed, which should render them ineligible to receive a lethal prescription. Thirteen of the 58 patients were diagnosed with anxiety.

Some of the patients in the study proceeded with physician-assisted suicide and others did not. Of those who committed suicide, 15 were not depressed and three were. The three depressed patients who killed themselves did so within two months of the research interview.

"The current practice of the Death with Dignity Act may not adequately protect all mentally ill patients," said the study's lead author, Dr. Linda Ganzini.

However, an editorial accompanying the paper noted that only a small number of depressed patients in the study killed themselves, which mirrors research conducted in the Netherlands. Dr. Marije van der Lee of the Helen Dowling Institute in the Netherlands argues that depressed patients are not necessarily incompetent.

"In the Netherlands the most important criteria for euthanasia and physician-assisted suicide is that the patient's suffering is hopeless and unbearable, and that the patient's request is voluntary and well  considered."

For more information and statistics, see the Web page for the State of Oregon's Death with Dignity Act.

-- Shari Roan

Photo: Linda Miles tapes a banner in Portland, Ore., on May 26, 2004, before the announcement that the 9th Circuit Court of Appeals upheld Oregon's Death with Dignity Act. Credit: Don Ryan/AP

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Comments (5)

Well, I guess if I were terminaly ill and looking forward to dieing in great pain I might be kind of depressed too. Silly.

I'm an Oregonian who, like the majority of voters on the Death With Dignity issue, voted twice on state ballot measures to have this option enacted into law. If your beloved dog or cat had advanced terminal cancer and was in uncontrollable pain, it would only be humane to have them put down. Adult human beings who are in the same situation should have the right to decide for themselves if that should be an option they can carry out.

Saying that "25% of the patients could be defined as clinically depressed" is very subjective (note the words "could be" rather than "is"). As to the patients diagnosed with anxiety, there is no explanation given of the CAUSE of that anxiety. I know I'd be somewhat anxious were I diagnosed with a terminal illness!

The law specifies that a person must make a written request, and have two non-related witnesses who are not the patient's caregivers and who will not be entitled to the patient's estate, that two physicians must agree the patient is suffering from a terminal disease, and verify that the patient is capable, is acting voluntarily and has made an informed decision. There is also a 15-day waiting period to have the prescription filled. The majority of Oregonians believe these are sufficient safeguards.

If you were physically impaired, definitively dying, your friends and spouse had died, you experienced constant physical pain, and you were incredibly lonely and bored, wouldn't it be perfectly natural to be depressed as well as ready to die? Only a crazy person in this circumstance would be happy and ready to die! Depression in dire circumstances is a sane reaction, not a mental illness that disqualifies you from choosing to end your life. Talk about your Catch-22!

What this report really tells us is that it's authors are simply opposed to assisted suicide and are using this depression study as an excuse to bolster opposition to Oregon's Death and Dying Law. Is there any place in America where chronically depressed citizens actually receive adequate and effective care if they are not independently wealthy? Far more suicides by a long shot are committed by depressed individuals without terminal illnesses simply because they receive less than adequate care if they receive any care at all.

I fail to see why depression, per se, should disqualify a patient from voluntarily seeking death. Depression is all too often treated as a strictly medical condition, and it admittedly does have psychological aspects. However, it never seems to occur to physicans & therapists that a patient's life may, in fact, be extremely depressing.
If one is suffering chronic, severe, debilitating pain, which prevents one from enjoying life and there is notreasonable hope/expectation the situation will ever change, depression can be expected, normal and justified. Suppressing that perfectly natural mental state via drugs is absurd. If a patient is in agony, rendering him mute and immobile and putting a bag over his head doesn't do anything for the patient. I just makes everyone around him feel better, since the patient is no longer complaining and looking sad.
The whole issue of suicide - assisted or otherwise - boils down to who 'owns' your life - you or society (as represented by professional with their own agenda).



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