Need for control drives assisted suicide seekers

People who request a doctor’s help in dying are doing so out of a desire to remain independent and in control, new research from Oregon shows.

At the time the study was done, Oregon was the only state in the US where physician-assisted suicide was legal; Washington state has since passed a nearly identical law, Dr. Linda Ganzini of Oregon Health & Science University noted in an interview with Reuters Health.

When Oregon passed its law in 1994, Ganzini added, the perception had been that people seeking help in dying would be vulnerable minority women without access to good end-of-life care. But these findings show that the real story is quite different, she said; “these are overwhelmingly white, well-educated, economically advantaged people who have a strong need to be in control.”

Most of what we know about these individuals has come through interviews with physicians, hospice providers, and patients’ family members, Ganzini pointed out, but not patients themselves. “This is the first study where we actually talked to the people who were pursuing this option.”

She and her colleagues surveyed 56 people in Oregon who had requested physician aid in dying or had gotten in touch with an advocacy organization for more information. By the end of the study, 41 had died, most within a couple of months of completing the survey. Eighteen had received a prescription for lethal medication, and nine died of a lethal drug overdose. Most of the study participants had cancer.

At the time they responded to the survey, Ganzini and her team found, people did not have a strong desire to die, and did not see their lives as “poor in quality, meaningless, or worthless.” Instead, the most important reasons people cited for seeking information on physician-assisted dying were wanting to be in control of how they died, wanting to die at home, and wanting to maintain their independence, along with fears about poor quality of life, pain, and inability to care for themselves in the future.

While some experts have suggested that providing better end-of-life care and symptom treatment will address the concerns of people interested in physician-assisted suicide, Ganzini noted, the study suggests that this isn’t the case. “Better palliative care for symptom management is important, but may not be an adequate response to these requests,” she said.

“It’s very hard to leave this world in the driver’s seat, but to the extent that we can recognize that as a valid value, we need to look for ways for people to stay in control as long as possible, even if they don’t have assisted suicide as an option.”

SOURCE: Archives of Internal Medicine, March 9, 2009.

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