Skip to main content

Advertisement

Log in

Motivations for physician-assisted suicide

Patient and family voices

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To obtain detailed narrative accounts of patients’ motivations for pursuing physician-assisted suicide (PAS).

DESIGN: Longitudinal case studies.

PARTICIPANTS: Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors.

SETTING: Participants’ homes.

MEASUREMENTS AND RESULTS: We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS.

CONCLUSIONS: Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient’s request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients’ concerns over time, and tailoring care accordingly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Doukas DJ, Waterhouse D, Gorenflo DW, Seid J. Attitudes and behaviors on physician-assisted death: a study of Michigan oncologists. J Clin Oncol. 1995;13:1055–61.

    PubMed  CAS  Google Scholar 

  2. Meier DE, Emmons CA, Wallenstein S, Quill T, Morrison RS, Cassel CK. A national survey of physician-assisted suicide and euthanasia in the United States. N Engl J Med. 1998;338:1193–201.

    Article  PubMed  CAS  Google Scholar 

  3. Emanuel EJ, Fairclough D, Clarridge BC, et al. Attitudes and practices of U.S. oncologists regarding euthanasia and physician-assisted suicide. Ann Intern Med. 2000;133:527–32.

    PubMed  CAS  Google Scholar 

  4. Foley KM. Competent care for the dying instead of physician-assisted suicide. N Engl J Med. 1997;336:54–8.

    Article  PubMed  CAS  Google Scholar 

  5. Ganzini L, Nelson HD, Schmidt TA, Kraemer DF, Delorit MA, Lee MA. Physicians’ experiences with the Oregon Death with Dignity Act. N Engl J Med. 2000;342:557–63.

    Article  PubMed  CAS  Google Scholar 

  6. Sullivan AD, Hedberg K, Fleming DW. Legalized physician-assisted suicide in Oregon—the second year. N Engl J Med. 2000;342:598–604.

    Article  PubMed  CAS  Google Scholar 

  7. Quill TE, Meier DE, Block SD, Billings JA. The debate over physician-assisted suicide: empirical data and convergent views. Ann Intern Med. 1998;128:552–8.

    PubMed  CAS  Google Scholar 

  8. Block SD, Billings JA. Patient requests to hasten death. Evaluation and management in terminal care. Arch Intern Med. 1994;154:2039–47.

    Article  PubMed  CAS  Google Scholar 

  9. Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000;284:2907–11.

    Article  PubMed  CAS  Google Scholar 

  10. Chochinov HM, Wilson KG, Enns M, Lander S. Depression, hopelessness, and suicidal ideation in the terminally ill. Psychosomatics. 1998;39:366–70.

    PubMed  CAS  Google Scholar 

  11. Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. Lancet. 1996;347:1805–10.

    Article  PubMed  CAS  Google Scholar 

  12. Emanuel EJ, Fairclough DL, Emanuel LL. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA. 2000;284:2460–8.

    Article  PubMed  CAS  Google Scholar 

  13. Ganzini L, Johnston WS, McFarland BH, Tolle SW, Lee MA. Attitudes of patients with amyotrophic lateral sclerosis and their care givers toward assisted suicide. N Engl J Med. 1998;339:967–73.

    Article  PubMed  CAS  Google Scholar 

  14. Bachman JG, Doukas DJ, Lichtenstein RL, Alcser KH. Assisted suicide and euthanasia in Michigan. N Engl J Med. 1994;331:812–3.

    Article  PubMed  CAS  Google Scholar 

  15. Back AL, Wallace JI, Starks HE, Pearlman RA. Physician-assisted suicide and euthanasia in Washington State. Patient requests and physician responses. JAMA. 1996;275:919–25.

    Article  PubMed  CAS  Google Scholar 

  16. Chin AE, Hedberg K, Higginson GK, Fleming DW. Legalized physician-assisted suicide in Oregon—the first year’s experience. N Engl J Med. 1999;340:577–83.

    Article  PubMed  CAS  Google Scholar 

  17. Lavery JV, Boyle J, Dickens BM, Maclean H, Singer PA. Origins of the desire for euthanasia and assisted suicide in people with HIV-1 or AIDS: a qualitative study. Lancet. 2001;358:362–7.

    Article  PubMed  CAS  Google Scholar 

  18. Back AL, Starks H, Hsu C, Gordon JR, Bharucha A, Pearlman RA. Clinician-patient interactions about requests for physician-assisted suicide: a patient and family view. Arch Intern Med. 2002;162:1257–65.

    Article  PubMed  Google Scholar 

  19. Morse J, Field PA. Qualitative Research Methods for Health Professionals. Thousand Oaks, CA: Sage Publications; 1995.

    Google Scholar 

  20. Bharucha A, Pearlman RA, Back AL, Gordon JR, Starks H, Hsu C. The pursuit of physician-assisted suicide: role of psychiatric factors. J Palliat Med. 2003;6:873–83.

    Article  PubMed  Google Scholar 

  21. van der Maas PJ, van Delden JJ, Pijnenborg L, Looman CW. Euthanasia and other medical decisions concerning the end of life. Lancet North Am Ed. 1991;338:669–74.

    Google Scholar 

  22. Ganzini L, Harvath TA, Jackson A, Goy ER, Miller LL, Delorit MA. Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. N Engl J Med. 2002;347:582–8.

    Article  PubMed  Google Scholar 

  23. Ganzini L, Dobscha SK, Heintz RT, Press N. Oregon physicians’ perceptions of patients who request assisted suicide and their families. J Palliat Med. 2003;6:381–90.

    Article  PubMed  Google Scholar 

  24. Kohlwes RJ, Koepsell TD, Rhodes LA, Pearlman RA. Physicians’ responses to patients’ requests for physician-assisted suicide. Arch Intern Med. 2001;161:657–63.

    Article  PubMed  CAS  Google Scholar 

  25. New York State Task Force on Life and the Law. When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context. Albany, NY, 1994.

  26. Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry. 1985;142:559–63.

    PubMed  CAS  Google Scholar 

  27. Chochinov HM, Wilson KG. The euthanasia debate: attitudes, practices and psychiatric considerations. Can J Psychiatry. 1995;40:593–602.

    PubMed  CAS  Google Scholar 

  28. Breitbart W, Rosenfeld BD, Passik SD. Interest in physician-assisted suicide among ambulatory HIV-infected patients. Am J Psychiatry. 1996;153:238–42.

    PubMed  CAS  Google Scholar 

  29. Humphry D. Final Exit: The Practicalities of Self-deliverance and Assisted Suicide for the Dying, 2nd ed. New York, NY: Dell; 1997.

    Google Scholar 

  30. Rosenfeld B, Breitbart W. Physician-assisted suicide and euthanasia. N Engl J Med. 2000;343:151; discussion 151–3.

    PubMed  CAS  Google Scholar 

  31. Cassell EJ. The Nature of Suffering and the Goals of Medicine, 2nd ed. New York, NY: Oxford University Press; 2004.

    Google Scholar 

  32. Kaufman SR. The Ageless Self: Sources of Meaning in Late Life. Madison: University of Wisconsin Press; 1986.

    Google Scholar 

  33. Bascom PB, Tolle SW. Responding to requests for physician-assisted suicide: “These are uncharted waters for both of us. ...” JAMA. 2002;288:91–8.

    Article  PubMed  Google Scholar 

  34. Pearlman RA, Starks H. Why do people seek physician-assisted death? In: Quill T, Battin MP, eds. Physician-Assisted Dying: The Case for Palliative Care and Patient Choice. Baltimore, MD: Johns Hopkins University Press; 2004;92–3.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert A. Pearlman MD, MPH.

Additional information

None of the authors has any financial or other conflicts of interest with respect to this work.

This manuscript was presented in part at the 24th annual meeting of the Society of General Internal Medicine, May 2001.

The Greenwall Foundation and the Walter and Elise Haas Fund provided funding for this research. The Veterans Health Administration (VHA) and the Health Services Research and Development Service of the Department of Veterans Affairs provided additional support. Kathleen Foley, Ezekiel Emanuel, and Susan Block gave valuable guidance and/or feedback on earlier drafts. Drs. Pearlman, Back, and Koenig were Faculty Scholars in the Project on Death in America (PDIA) of the Open Society Institute. The views expressed in this article are those of the authors and do not necessarily represent the views of the funding sources, Department of Veterans Affairs, Project on Death in America, University of Washington, University of Pittsburgh, or persons mentioned above.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pearlman, R.A., Hsu, C., Starks, H. et al. Motivations for physician-assisted suicide. J GEN INTERN MED 20, 234–239 (2005). https://doi.org/10.1111/j.1525-1497.2005.40225.x

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2005.40225.x

Key words

Navigation