Diane E. Meier, et al., surveyed 3,021 physicians younger than 65 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
TABLE 3.1
Characteristics of patients requesting and receiving physician-assisted death, 2003
| Number (%) | |||
| Total sample* (sample size = 415) | Requested lethal prescription (sample size = 215) | Requested lethal injection (sample size = 105) | |
| Female sex | 155 (39) | 74 (35) | 39 (39) |
| White race/ethnicity | 346 (89) | 183 (90) | 87 (86) |
| Religion | |||
| Roman Catholic | 55 (17) | 23 (14) | 16 (20) |
| Other Christian | 199 (61) | 103 (62) | 55 (68) |
| Jewish | 31 (10) | 20 (12) | 5 (6) |
| Other | 8 (3) | 3 (2) | 1 (1) |
| None | 31 (10) | 18 (11) | 4 (5) |
| Age | |||
| 19–45 | 72 (18) | 38 (18) | 24 (23) |
| 46–75 | 226 (56) | 125 (59) | 52 (50) |
| >75 | 103 (26) | 49 (23) | 28 (27) |
| Social class | |||
| Upper | 61 (15) | 27 (13) | 17 (17) |
| Middle | 285 (71) | 149 (71) | 74 (73) |
| Lower | 54 (14) | 33 (16) | 11 (11) |
| Education | |||
| None or elementary school | 35 (10) | 11 (6) | 19 (23) |
| High school graduate | 146 (43) | 84 (46) | 35 (43) |
| College graduate | 161 (47) | 88 (48) | 28 (34) |
| Primary diagnosis | |||
| Human immunodeficiency virus | 55 (13) | 31 (14) | 12 (11) |
| Cancer | 194 (47) | 100 (47) | 45 (43) |
| Neurologic disease | 53 (13) | 29 (14) | 13 (12) |
| Other | 113 (27) | 55 (26) | 35 (33) |
| Experiencing severe pain | 156 (38) | 71 (33) | 40 (39) |
| Experiencing severe discomfort other than pain | 170 (42) | 77 (36) | 54 (52) |
| Confused | 39 (10) | 15 (7) | 22 (21) |
| Depressed at time of request | 202 (49) | 108 (52) | 43 (41) |
| Experienced recent deterioration in functional status | 313 (87) | 150 (86) | 89 (87) |
| Dependent for most or all of personal care | 217 (53) | 96 (45) | 71 (68) |
| Bedridden | 173 (42) | 62 (29) | 68 (65) |
| Physicians' estimate of life expectancy | |||
| <1 month | 114 (28) | 27 (13) | 63 (61) |
| ≥1 month | 294 (72) | 185 (87) | 40 (39) |
| Duration of patient-physician relationship | |||
| <1 month | 68 (19) | 24 (13) | 27 (30) |
| 1 month to 1 year | 100 (28) | 62 (33) | 15 (17) |
| >1 year | 191 (53) | 101 (54) | 47 (53) |
| Source of request | |||
| Patient or patient with family | 361 (89) | 201 (95) | 72 (71) |
| Family only | 46 (11) | 11 (5) | 30 (29) |
| Type of request | |||
| Lethal prescription | 215 (52) | 215 (100) | 0 |
| Lethal injection | 105 (25) | 0 | 105 (100) |
| Either prescription or injection | 95 (23) | 0 | 0 |
| *Total sample included 215 who requested a lethal prescription, 105 who requested a lethal injection, and 95 who made a nonspecific request. | |||
| SOURCE: Diane E. Meier, et al., "Table 1. Characteristics of Patients in Sample: Overall and by Type of Request," in "Characteristics of Patients Requesting and Receiving Physician-Assisted Death," Archives of Internal Medicine,vol. 163, July 14, 2003 | |||
patient's life." Of the 3,021 physicians surveyed, 1,902 (63 percent) responded.
Table 3.1 contains descriptions of physicians' most recent patient and family requests for assistance in dying. More than half the patients described were male (61 percent) and most of the patients were white (89 percent). Nearly half (47 percent) of those in the sample were college graduates, and nearly half (47 percent) had cancer as a primary diagnosis. Infection with HIV was the primary diagnosis for 13 percent. Many (38 percent) were experiencing severe pain and 42 percent were experiencing severe discomfort other than pain. About half (49 percent) were depressed (as diagnosed by their physicians) at the time of their request, were dependent for most or all of their personal care (53 percent), and were bedridden (42 percent). Nearly three-quarters of those in the sample (72 percent) were expected to live one month or more, while the remaining 28 percent were expected to live less than a month. About half of those in the sample requested a lethal prescription (52 percent) 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. Table 3.2 is an analysis of data from physicians who did honor such requests. It shows those factors that significantly increased the likelihood that a physician would honor a request for aid in dying. These factors are considered predictors of request-honoring behavior, and the column "odds ratio" shows the likelihood of a factor (compared to other listed factors) influencing a physician to comply with the request.
The factor most likely to predict that a physician would honor a request for aid in dying was the specificity of the request. (See Table 3.2.) 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. (See Table 3.3.) 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
TABLE 3.2
Independent patient-related factors associated with physicians honoring a request for hastened death, 20031
| Odds ratio | |
| Type of request2 | |
| Prescription | 43 |
| Injection | 106 |
| Patient depressed at time of request | 0.2 |
| Patient in severe pain | 2.4 |
| Patient in severe discomfort other than pain | 6.5 |
| Patient life expectancy <1 month | 4.3 |
| 1Responses from physicians who stated that they would not honor a patient's request for assistance in dying under any circumstances were excluded from the analysis. | |
| 2Reference category was nonspecific request for prescription or injection. | |
| SOURCE: Diane E. Meier, et al., "Table 2. Independent Patient-Related Factors Associated with Physicians Honoring a Request for a Hastened Death," Archives of Internal Medicine, vol. 163, July 14, 2003 | |
depressed at the time of their requests were less likely to have their requests honored than those who were not depressed.
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