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