Questionable study on euthanasia and social connectedness

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A study was published on April 16, 2024 titled: The association between social connectedness and euthanasia and assisted suicide and related constructs. 

The concern with loneliness and isolation in relation to deaths by euthanasia and assisted suicide is real, but this study disagrees. The study concludes:

Our findings for all age groups are consistent with a those of a previous systematic review focused on older adults and suggest that poor social connectedness is not a clear risk factor for EAS or for measures more distally related to EAS.

The study acknowledges its weaknesses, nonetheless I found this study to be questionable because it was based on data from previous studies (no new research) and the data was not primarily based on interviews with people.

The best study on this topic was done by van der lee et al and published in the Journal of Clinical Oncology in September 2005 titled: Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients

van der lee is a Dutch researcher who supported euthanasia and indicates that the purpose of the study was to prove that there was not an association between euthanasia and depression. In her explanation of the study van der lee states:

Second, in our experience, requests for euthanasia are mostly well considered and commonly not associated with depression.

We therefore expected that patients requesting euthanasia might be even less depressed.

The conclusion of the study was opposite to its premise:

Of 138 patients, 32 patients had depressed mood at inclusion. Thirty patients (22%) made an explicit request for euthanasia. The risk to request euthanasia for patients with depressed mood was 4.1 times higher than that of patients without depressed mood at inclusion (95% CI, 2.0 to 8.5).

Depression in cancer patients with an estimated life expectancy of less than 3 months is associated with a higher likelihood to request for euthanasia. The question of whether depressed mood can adequately be treated in this terminally ill population, and if so, whether it would lower the incidence of requests for euthanasia needs further investigation.

The significance of the van der lee study was that the conclusion was counter to the bias of the researchers. Therefore you can't argue that research bias led to the outcome of the study.

Another strength with the van der lee study is that the researchers interviewed the participants in the study. The data was based on actual people who were requesting death by euthanasia in a country where it was legal and accepted.

Another important study that was based on communication with the participants is the Irish longitudinal study that examined the wish to die (WTD) among 8174 patients who were over the age of 50. The study that was published in February 2021 followed the participants for 6 years and it determined that people who had a wish to die (WTD), almost three-quarters reported being lonely and 60% had clinically significant depressive symptoms. Other factors leading to a WTD was functional disability and chronic pain.

When the WTD was reassessed two year later, 72% of the people indicated that loneliness and depression had receded, re-affirming previous studies that prove that a WTD fluctuates.

Once again, the strength of this study was that the data came from actual communication with participants and there was no known bias associated with the researchers. 

I am convinced by the studies that obtain their data from actual participants and I am convinced from the anecdotal experience I have in personally speaking to many people who are seeking to request or who have actually been approved for MAiD.

As stated in the conclusion of the van der lee study:

Our findings suggest that depressed mood in the last months of life is associated with a higher risk for request for euthanasia.

There is a direct relationship between requests to have one's life ended by euthanasia or assisted suicide and one's feelings of hopelessness, depression and loneliness. 

I have also found through conversations with people who have been approved for euthanasia that suicidal ideation is also prevalent.