Depression and physician assisted suicide

People in Washington State need to be aware that if the I-1000 assisted suicide Initiative is passed, people who experience depression will not be effectively protected under "Oregon Style" guidelines.

The recently published study by Ganzini et al proves that 26% of people in Oregon who requested assisted suicide were experiencing depressive disorders. Even though many of those people were incompetent or unable to "freely choose" assisted suicide that in fact they were given a prescription for lethal drugs and died by ingesting those drugs.

The study by Linda Ganzini, Elizabeth R. Goy, and Steven K Dobscha - BMJ2008;337;a1682 states in its conclusion:

Our study suggests that most patients who request aid in dying do not have a depressive disorder. However, the current practice of the Death with Dignity Act in Oregon may not adequately protect all mentally ill patients, and increased vigilance and systematic examination for depression among patients who may access legalised aid in dying are needed. Tools for screening for depression such as those used in our study are easy to administer and may help to determine which patients need further evaluation by a mental health professional. Further study is needed to determine the effect of treatment of depression on the choice to hasten death.

What is important about this study is that Ganzini et al do not oppose physician assisted suicide, but are rather concerned about the implications of such a law.

Since the Oregon assisted law was enacted to allow assisted suicide for adults who are competent, terminally ill, and voluntarily choosing to end their life. Therefore this study is important based on the fact that a person who is depressed is usually incompetent or unable to freely choose to end their life.

The Euthanasia Prevention Coalition believes that physician assisted suicide directly threatens the lives of the most vulnerable in our society. That doesn't mean that, when legal, only vulnerable people die by assisted suicide, but rather a vulnerable person, which includes but is not limited to people who are experiencing symptoms of depression, are more likely to die by assisted suicide than the general population of terminally ill people.

Ganzini et al, studied 58 patients in Oregon who requested assisted suicide. Most of these people were dying of cancer or ALS - Lou Gehrig's disease.

Ganzini et al specifically studied patients who had requested assisted suicide:

our surveyed participants had taken active steps to pursue a physician's aid in dying in one of the few jurisdictions where it is legal - all either explicitly requested aid in dying from a physician or contacted Compassion and Choices for information on the Oregon Death with Dignity Act. Before death, almost half had obtained a prescription for a lethal drug under the law.

Of the 58 people who participated in the study, 26% (15) were independently diagnosed with depression.

The study stated:

Among patients who requested a physician's aid in dying, one in four had clinical depression. However, more than three quarters of people who actually received prescription for lethal drugs did not have a depressive disorder. Our findings also indicate that the current practice of legalised aid in dying may allow some potentially ineligible patients to receive a prescription for a lethal drug; two of those who ultimately died by lethal ingestion had depression at the time that they received a prescription for a lethal drug and died by ingestion the drug. A third patient was depressed at the time that she requested a physician's aid in dying and probably received her prescription; she was successfully treated for her depression before she died by lethal ingestion.

Further to the concern in Oregon that people with depressive disorders are dying by assisted suicide Ganzini et al acknowledge that:

In a study of 321 psychiatrists in Oregon only 6% were very confident that in a single evaluation they could adequately determine whether a psychiatric disorder was impairing the judgement of a patient requesting assisted suicide. In a study of 290 US forensic psychiatrists, 58% indicated that the presence of major depressive disorder should result in an automatic finding of incompetence for the purpose of obtaining assisted suicide.

Proponents of assisted suicide will say that since their are safeguards in Oregon that mandate that someone who has a depressive disorder or mental illness must receive a psychiatric or psychological assessment before receiving a prescription for a lethal drug, that these few cases simply represent an oversight by the physician.

The reality is that of the 49 cases of assisted suicide in Oregon last year, none of them were referred for a psychiatric or psychological assessment.

In other words, safeguards in Oregon are either ignored or completely ineffective and Ganzini et al proves it.

Link to the abstract in the British Medical Journal - BMJ 2008;337:a1682:
http://www.bmj.com/cgi/content/abstract/337/oct07_2/a1682?ijkey=bc7d37e92efbfea7ce03a2d59bfd0c8b4623fa04
Link to the article in the Oregon Public Broadcasting - OPB News:
http://news.opb.org/article/3248-new-study-depression-and-assisted-suicide/

Link to the article in the Healthcare Republic:
http://www.healthcarerepublic.com/news/GP/851763/Assisted-suicide-patients-could-treated-depression/