Some depressed patients opt for assisted suicide

By Anthony J. Brown, MD
NEW YORK (Reuters Health) - The results of a survey in Oregon suggest that the Death with Dignity Act enacted in the state in 1997 does not always prevent patients with depression, a treatable condition, from receiving a prescription for a lethal drug.
The findings indicate that "most people in Oregon who request physician aid in dying do not have clinical depression," but yet there are "small number of patients with clinical depression who are able to access lethal medications," lead investigator Dr. Linda Ganzini, from Portland Veterans Affairs Medical Center, told Reuters Health.

"The Oregon law," she explained, "requires that if the prescribing physician is concerned that the patient might have depression influencing their judgment, that they be evaluated by a psychiatrist or psychologist. The proportion of requesting patients who are evaluated by a mental health professional has been dropping over the last decade and last year no mental health assessments occurred among the 46 people who died by physician-assisted suicide in Oregon."
The survey, reported in the Online First issue of the British Medical Journal, looked at 58 state residents with a terminal illness, usually cancer or ALS, who had requested assistance in dying, either directly from a physician or through an advocacy organization.
Using standard measures, including the structured clinical interview of the Diagnostic and Statistical Manual of Mental Disorders, the investigators identified 15 people with depression and 13 with anxiety.
Forty-two people died by the end of the study, including 18 who had received a prescription for a lethal drug. Three of the 18 individuals met criteria for depression and all three died from lethal ingestion within 2 months of the study survey.
"Physicians need to do a better job in screening for depression among terminally ill patients who wish to die," Ganzini emphasized. She added that her group "is continuing to analyze data from this data set regarding these patients' views on their medical care."
In a related editorial, Dr. Marije L. van der Lee, from the Helen Dowling Institute in Utrecht, the Netherlands, comments that while the current study examined how well depressed patients are protected from assisted suicide, the focus should be on "trying to prevent patients from becoming depressed in the first place."
She added that "depression has a strong negative effect on the quality of life of terminally ill patients and their family, but depression could potentially be treated."
SOURCE: British Medical Journal, online October 8, 2008.

2008 Reuters.