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Why do some people request assisted suicide?

Dr Karen Hitchcock

Dr Karen Hitchcock

Doctor and author, Australia

“Over the 12 years that I have worked as a doctor in large public hospitals, I have cared for hundreds of dying patients. No one has ever died screaming or begging for me to kill them. Patients have told me they want to die. My response to this is “Tell me why.” It is rarely because of pain, but it is often because of despair, loneliness, grief, the feeling of worthlessness, meaninglessness or being a burden. I have never seen a dying patient whose physical suffering was untreatable. The combination of morphine and midazolam is extremely powerful; it can be administered and titrated up very quickly. Barbiturates can render one unconscious in minutes. Palliative care practices have come a long way in the past decade.

“Studies repeatedly show that the desire to hasten death for those with a terminal illness comes principally from a feeling of hopelessness. We must listen to and attempt to address this and other fears. Knowing one is dying can be excruciating: the terror of non-existence. For thousands of well-educated, affluent people in vocal advocacy groups, a euthanasia drug like Nembutal is the sole way to wrest control of the only part of their life they may not fully control.” Read the full “must-read” article here

Find her Quarterly Essay: On Healthcare and ageing here
 
 
Photo: Quarterly Essay
 


Oregon

 
In the US State of Oregon assisted suicide is legal for terminally ill people who are expected to live for six months or less.
 
 

Only a tiny percentage of terminally ill people die from assisted suicide

 
In 2014, less than 1 % (0.91 %) of patients with terminal cancer died from assisted suicide (721out of 7,8622).
 
In the same year, only 13 % of patients with ALS died from assisted suicide (173out of 1294).
 
 

People request assisted suicide mainly for non-physical reasons

 
The graph below shows the percentage of people who cited a particular reason for requesting assisted suicide, according to the 2014 official report. People were allowed to give more than one reason.

The top reasons are existential, or spiritual in a broad sense: they have to do with purpose, meaning and values. They are not dependent on particular physical symptoms and are not unique to terminally ill people. People with disabilities, chronic conditions, depression or other mental illnesses may have similar concerns.

People were asked whether they concerned about pain and control over bodily functions, not whether they had actually experienced these issues. Concerns about losing control over bodily functions and pain have both physical and psychological components. These concerns are not unique to terminally ill people either.
 
 
What about Cancer and Pain and Assisted Suicide?
 
“There is an inverse relationship between cancer patients experience with pain and their favoring assisted suicide. People with cancer are less in favor or assisted suicide than is the general public. Patients with pain want doctors to treat the pain, not kill the patient. In Oregon, a small minority of patients dying of assisted suicide chose it because of fear of pain in the future, not because they were actually having pain.” – Physicians for Compassionate Care Education Foundation, Oregon
 
 

Reasons why people request assisted suicide in Oregon (graph): Losing autonomy (91%), Less able to engage in activities making life enjoyable (87%), loss of dignity (71%), Losing control of bodily functions (50%), Being a burden on family, friends or caregivers (40%), Inadequate pain control or concern about it (31%), Financial implications of treatment (5%).
  1. Oregon Public Health Division (2015, February 2). Oregon’s Death with Dignity Act –2014. p.5. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
  2. Oregon Health Authority (2015, November). Leading causes of death by county of residence. Oregon vital statistics data 2014, Table 18. Retrieved from https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/annualreports/CountyDataBook/Documents/2014/table18-2014.pdf
  3. Oregon Public Health Division (2015, February 2). Oregon’s Death with Dignity Act –2014. p.5. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
  4. Oregon Health Authority (2015, November). Leading causes of death by county of residence. Oregon vital statistics data 2014, Table 18. Retrieved from https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/annualreports/CountyDataBook/Documents/2014/table18-2014.pdf