Psychiatrists who work with medically ill patients are strongly opposed to participating in or endorsing physician-assisted death, according to a new survey.
At the 1995 annual meeting of the Academy of Psychosomatic Medicine, 184 consultation-liaison psychiatrists - who play a large role in the ccare of dying patients - responded to a questionnaire about six scenarios in which patients or family members asked for help in dying. In each they were asked whether or not they probably or absolutely would assist the patient or were "uncertain" what they would do. The results are published in the current issue of the journal Psychosomatics.
In four of the hypothetical cases the psychiatrists on average strongly opposed assisting the patient to die. In a fifth case, a hypothetical 30-year-old man with advanced Lou Gherig's disease, they were mostly uncertain.
Only in the case of a 27-year-old AIDS patient who had been in a coma for two months and was deemed by her family to be "brain dead" were the psychiatrists uniformly in favor of taking her off a respirator. "This case," the researchers write, "demonstrated that the respondents differentiated between withdrawal of life-support measures and assisted-death practices."
"To my knowledge," said the sstudy's principal author, Laura Roberts, MD, of the University of New Mexico School of Medicine, "this is the first study of assisted death with psychiatrists drawn from a national sample, and the first study ever of consultation-liaison psychiatrists' views on this issue."
While psychiatrists in the study did not support either non-physicians or themselves personally assisting death, they were somewhat more accepting of referrals to other physicians and other physicians' involvement. The researchers noted that psychiatrist opposition to assisted death, as reflected in their study, was greater than in earlier surveys of physicians:
- In a Washington State survey, 53 percent of physicians thought assisted death should be legal, 40 percent said they would perform it, and psychiatrists were described as more accepting of it than other specialists..
- In an Oregon survey, 60 percent of physicians said assisted death should be legal and 46 percent said they would prescribe a lethal dose of a drug if it were legal.
Requests for assisted death are likely to be the product of depression, a treatable illness. Studies show that 20 percent of patients who are terminally ill suffer from major depression, and 60 percent of those who request assistance with dying are clinically depressed.
The authors write: "Our findings reflect the struggle we experience...in caring for our most vulnerable patients.... (Consultation-liaison) psychiatrists appreciate the psychiatric aspects of suicide and physician-assisted death and the precarious nature of informed consent in vulnerable and seriously ill patients. Viewed more positively ... psychiatrists appear optimistic, rejecting the option of immediate death in cases in which the potential for a better life, or at least a better proccess of dying, might exist for the patient."
Other participants in the study are from the University of New Mexico, Columbia-Presbyterian Medical Center (New York), Veterans' Administration Medical Center (Albuquerque, NM), and West Virginia University.
Psychosomatics, the official journal of the Academy of Psychosomatic Medicine, publishes peer-reviewed research and clinical experiences in the practice of medical-surgical psychiatry. For further information, contact Tom Wise, MD, at (703) 698-3626.
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Psychosomatics