Terminally Ill Do Not Favor Assisted Suicide

People with intense, unremitting pain are less likely to request mercy killing or physician-assisted suicide than is generally believed. While two-thirds of the general public say they endorse assisted death, only 12 percent of cancer patients in constant pain actually initiated conversations about it with their doctors and families.

"People may look at terminally ill patients in pain and think: 'I'd rather die than be like that,' " said Ezekiel Emanuel, assistant professor of medicine at Dana-Farber Cancer Institute. "But our data indicate that what these patients are really interested in is getting rid of their pain, not in dying. Having pain, in and of itself, apparently does not predispose people to desire or take action to actively end their life."

Emanuel and his colleagues interviewed 155 cancer patients, 193 nonpatients, and 355 cancer specialists in the first survey of its kind in the U.S. The findings, he noted, "are consistent with what we know from studies in the Netherlands, where pain is a contributing reason for euthanasia (mercy killing) in less than half the cases, and the sole reason in only 10 percent of cases."

The American study found that patients most likely to ask for help in dying were driven by depression. This relationship "needs to be confirmed with additional research," Emanuel said. If it is confirmed, "intervention using antidepression medications or psychotherapy should be tested to see if they reduce patients' interest in euthanasia and physician-assisted suicide."

More than half (57.2 percent) of the cancer specialists surveyed said they had received requests for life-ending drugs to be administered either by the doctor or patients themselves. About 14 percent complied.

Yet the majority of cancer patients in the survey said they considered the procedures unethical and would change their physician if he or she admitted to performing them in the past. The majority also said that discussing assisted death with their doctor would decrease their trust in him or her, perhaps because of fear that it might lessen the physician's interest in treating them.

Only 27 percent of the terminally-ill had serious thoughts about asking for assisted death, and less than half of them held conversations about it with their doctor or family.

By contrast, patients, physicians and the public agreed it is proper for doctors to increase doses of pain killers, like morphine, to control pain, even if premature death results. This practice is considered both ethical and legal.

Overall, the study findings "suggest that before our society rushes into legalizing euthanasia and physician-assisted suicide, we need to understand more clearly which patients want these interventions and why," Emanuel said. "The data also suggest that regardless of their interest in physician-assisted suicide, patients want us to improve pain management practices."
- William J. Cromie