Diane E. Meier et al surveyed 3,021 physicians younger than sixty-five years from the 1996 American Medical Association Physician Master File in August 1996 ("Characteristics of Patients Requesting and Receiving Physician-Assisted Death," Archives of Internal Medicine, vol. 163, no. 13, July 14, 2003). The researchers wanted to determine patient characteristics associated with acts of physician-assisted suicide. Physician-assisted suicide was defined as "writing a prescription or administering a lethal injection with the primary intention of ending the patient's life." Of the 3,021 physicians surveyed, 1,902 (63%) responded.
More than half the patients requesting and receiving physician-assisted death were male (61%) and most of the patients were white (89%). Nearly half (47%) of those in the sample were college graduates, and nearly half (47%) had cancer as a primary diagnosis. Infection with HIV was the primary diagnosis for 13%. Thirty-eight percent were experiencing severe pain and 42% were experiencing severe discomfort other than pain. About half (49%) were depressed (as diagnosed by their physicians) at the time of their request; 53% were dependent for most or all of their personal care; and 42% were bedridden. Nearly three-quarters of those in the sample (72%) were expected to live one month or more, while the remaining 28% were expected to live less than a month. About half of those in the sample requested a lethal prescription (52%) to hasten their death.
Meier and her colleagues analyzed their survey data to identify factors associated with a physician honoring a request for aid in dying. The factor most likely to predict that a physician would honor such a request was the specificity of the request. That is, specific requests for assistance, such as requests for lethal prescriptions or lethal injections, were predictors of requests being honored, while nonspecific requests were not predictors of requests being honored. Other predictors of physicians' decisions to honor patients' requests for assistance in dying included severe pain, severe discomfort other than pain, and a life expectancy of less than one month. Some patients were believed to be depressed at the time of their request, and although physicians did honor some of these requests, they were less likely to honor a request if they knew the patient was depressed.
Further analysis of the survey data identified factors associated with a physician honoring a request for aid in dying for patients requesting a lethal injection and those requesting a prescription for a lethal dose of medication. For patients requesting a lethal injection, those with severe physical discomfort other than pain and patients with a life expectancy of less than one month were significantly more likely to have their request honored than patients without these characteristics. For patients requesting a prescription for a lethal dose of medication, those with severe pain and severe physical discomfort other than pain were significantly more likely to have their request honored than patients without these characteristics. In both groups patients who were depressed at the time of their requests were less likely to have their requests honored than those who were not depressed.
Marijke C. Jansen-van der Weide, Bregje D. Onwuteaka-Philipsen, and Gerrit van der Wal published a study in 2005 that revealed characteristics of patients in the Netherlands who explicitly requested euthanasia or physician-assisted suicide between April 2000 and December 2002. Table 3.2 shows that, as in the Meier study, more than half the patients requesting euthanasia and assisted suicide (EAS) were male (54%). Most of the patients were diagnosed with cancer (90%), a greater percentage than in the Meier study. Although only 9% were diagnosed with depression, 92% were "feeling bad." The three most often cited reasons for requesting EAS were pointless suffering (75%), deterioration or loss of dignity (69%), and weakness or tiredness (60%).
Results of the Jansen-van der Weide et al study shed some light on reasons why physicians were reluctant to grant requests for EAS (see Table 3.3.) Of the 570 patients who had initially requested EAS, sixty-five died before EAS was administered, seventy-two died before a final decision was rendered, sixty-eight changed their mind and no longer wanted EAS, 101 were refused, and 253 had their requests carried out. Physicians caring for patients in all five categories were reluctant to grant the EAS request in some cases. Physicians caring for 52% of the "refused" patients cited doubts about their patients' hopeless and unbearable suffering. This doubt was prevalent across groups. Other common doubts expressed by physicians were those about the availability of alternative treatment, personal doubts in particular cases, doubts about the patient being depressed, and doubts about a well-considered and persistent request. Not usually significant in a physician's reluctance to grant EAS were concerns that the patient was too close to death, that the request for EAS was voluntary, and that the family was against EAS.
Table 3.4 shows the odds ratio (OR) for factors associated with refusing a request for EAS. A factor shown in the table with a high OR was more likely than a factor with a lower OR to influence a physician to refuse a request for EAS. The table shows that the factor most likely to have influenced a physician to refuse an EAS request was the patient not being competent or fully competent (did not have all of his or her mental faculties). Two other factors associated with refusal were the physician's perception that the patient's unbearable or hopeless suffering was experienced to a lesser extent than would be necessary to consider EAS. The lower portion of the table shows that depression was the reason most likely to have influenced a patient to request EAS, while not wanting to burden their family was the second most influential factor.
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