Response to the editorial concerning study on: Depression and Physician Assisted Suicide

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Alex Schadenberg

The recently published study by Ganzini et al shows that 26% of people who took part in this study in Oregon who had requested assisted suicide were experiencing depressive disorders.

The study by Linda Ganzini, Elizabeth R. Goy, and Steven K Dobscha was recently published in the British Medical Journal - BMJ 2008;337;a1682.

I was dismayed by the Editorial that was published in the British Medical Journal - BMJ 2008;337:a1558 written by the Dutch researcher and oncologist Marije L. van der Lee of the Helen Dowling Institute.

van der Lee was the author of the important study that showed that a correlation exists between the incidence of depression with requests for euthanasia in the Netherlands. Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients - Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6607-6612

Based on the Editorial written by van der Lee, it appears that we can expect that the the new response by the euthanasia lobby to the relationship between euthanasia/assisted suicide and depression is to acknowledge that the relationship exists and deny that it is important.

van der Lee writes in the editorial:

Determining whether depression impairs the judgement of a patient requesting assisted suicide is more complex, because depressed patients are not necessarily incompetent. ... Ganzini and colleagues report that only 6% of psychiatrists in Oregon were confident they could adequately determine in a single evaluation whether a psychiatric disorder impaired the judgement of a patient requesting assisted suicide. Doctors who have known their patient for some time can often determine their patient's level of competency. In the Netherlands and Oregon, consultation with a second doctor is already standard procedure, so a psychiatrist should be consulted only when the patient's ability to make a decision is in doubt.

van der Lee is saying that people who are depressed will make requests for euthanasia and assisted suicide but having a depressive disorder does not make the person incompetent. Further to that, van der lee seems to be saying that since there is a requirement of having a second doctor agree to a request for euthanasia or assisted suicide, then the fear of someone who is incompetent dying by lethal injection or ingestion is minimal at best.

In reality van der Lee is simply creating a new paradigm for the fact that their is a direct corelation between people suffering from depression and dying from euthanasia. It is easier to write the concerns off as trivial than recognize the serious problem for what it is.

van der Lee also rejects the concerns of the study that Ganzini acknowledged that stated:

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.

Finally van der Lee ignores the fact that last year in Oregon, none of the 49 people who died by assisted suicide were referred for a psychiatric or psychological assessment, even though the Ganzini study notes at least two people who participated in the study were depressed when they died from ingesting lethal drugs. This fact should further concern van der Lee because the van der Lee and Ganzini studies both concluded that 17% of those in the study who died by euthanasia or assisted suicide were depressed. We can assume that in the Netherlands very few people are referred for a psychiatric or psychological assessment before they are injected with death.

This conclusion corelates with the hypothesis that was presented in the van der Lee study which was:

.. we hypothesized that depressed mood would show an inverse association with requests for euthanasia. Our clinical impression was that such requests were well-considered decisions, thoroughly discussed with healthcare workers and family. We thought the patients requesting euthanasia were more accepting their impending death and we therefore expected them to be less depressed. To our surprise, we found that a depressed mood was associated with more requests.

Further to that van der Lee stated in the study:

Opposition stems partly from the perspective of suicide as a symptom of mental illness and the tendency to extend this view of suicide in the physically healthy onto euthanasia and physician-assisted suicide in the terminally ill.

In other words, van der Lee conducted the study that was published by the Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6607-6612; to counter the opposition to euthanasia that has been expressed concerning vulnerable people with mental illness.

The further concern is whether van der Lee is capable of effectively responding to the Ganzini study.

The editorial by van der Lee suggests that she is attempting to cover up the reality of the relationship between depression and euthanasia rather than analyze the Ganzini findings. We must need to be aware of the new directions and verbal gymnastics that the euthanasia lobby incorporates.

van der Lee has introduced the concept that depressed people can be prescribe death by assisted suicide.

Link to the editorial by van der Lee in the British Medical Journal: (Link)