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Depression in Assisted Suicide/Euthanasia Patients

Posted Dec 23 2008 9:14pm

The abandoning ethic of assisted suicide is demonstrated by studies showing depression in many patients requesting hastened death. This point is commented upon in a letter to the editor in the British Medical Journal by Thomas Koch, a Canadian professor at the University of British Columbia. There is no link (BMJ 2008;337:a2479), so I am quoting it in full (citations omitted):

Nobody should be surprised at the prevalence of depression and anxiety in Oregon patients requesting physician assisted suicide. This was the pattern of euthanasia’s expansion in Holland--a movement for relief of unbearable suffering in terminal cases became a means of termination for those whose problems were often more existential, or psychological, than physical. In Holland the critical case in law and ethics was the
Chabot case, in which a divorced woman with clinical depression after the death of a son asked for, and received, euthanasia.
[Me: Actually, the deaths of two sons and she received assisted suicide.] In another case, a request for euthanasia by a young woman with anorexia later was granted.

A retrospective study of deaths attributed to Dr Jack Kevorkian found none with end stage disease and several in whom necropsy revealed no clear organic dysfunction. [Me: End stage disease, probably so. But to avoid confusion, about 25% of Kevorkians assisted suicides had been diagnosed with terminal conditions.] Again,what was publicly proclaimed as an end to suffering became a matter of termination of people whose physical or psychological suffering was not correctly palliated or treated.

Depression attends generally to cases of physical limit and chronic disease. The focus on euthanasia rather than on treatment, and state support for palliative and psychological treatment makes premature physician assisted death a default option. This ignores in the name of autonomy a wealth of evidence that argues that most of those with chronic limits and progressive conditions may, after an initial period of anxiety and depression, find a worthiness to life so long as physical and
psychological treatment is provided. It similarly ignores the potential for fruitful life with both aggressive palliative care and psychological support.

The same is true of people diagnosed with a terminal illness. Assisted suicide uses the language of "compassion," but it really is a form of giving up on the patient. Worse, when the state explicitly authorizes it, the messages are sent that dying naturally is not dignified, and moreover, that killing oneself is at least as good a choice as allowing nature to take its course. That "approval" may provide the tipping point--which is why assisted suicide advocates work so hard to prevent any nay saying by relevant medical professionals to patients once it becomes law, and try to change the language from "suicide," which has a negative connotation, to the euphemistic "aid in dying," which seems benign, and is what hospice does, after all.

But it strikes me that unequivocal societal disfavor of these actions--while not disfavoring any patients, and in fact, supporting suicidal people--would mean fewer suicides all the way around.

Labels: Assisted Suicide. Depression.

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