Assisted Suicide Examined Study Finds Independence, Dignity - Not Pain - At Issue

Dying patients who ask doctors to help them end their lives are more concerned about losing their dignity and independence than about physical pain, a new study indicates.

The study also found that nearly a quarter of patients who asked for help in committing suicide got a prescription for that purpose, even though physician-assisted suicide is illegal in Washington.

Because doctors were the study’s focus, it’s not clear whether patients feared the dying process or life in their current condition. But the data suggest “intolerable physical symptoms are not the reason” most sought death, said the study, led by Dr. Anthony L. Back of the University of Washington and the Veterans Affairs Puget Sound Health Care System.

Patients’ concerns “underscore the importance of autonomy and self-determination” at this crossroads, and the findings suggest a need “to address nonphysical concerns,” the authors wrote.

The study, published in this week’s Journal of the American Medical Association, was based on questionnaires mailed in 1994 to 1,453 Washington state doctors - a random sampling of 25 percent of principal-care physicians, and all doctors in specialties likely to treat the terminally ill. A total of 828 doctors, 57 percent, responded.

Researchers found that 218, or 26 percent, of the responding doctors had been asked by patients at least once to help hasten death. Of those, 147 doctors described 207 cases, including 156 requests for physician-assisted suicide and 58 for euthanasia. Some patients sought both types of assistance.

Roughly a quarter of the requests were granted. About 40 percent of the patients given prescriptions to end their lives did not use them, the study found.

“Perhaps they just needed the reassurance that they could kill themselves if they wished,” said Dr. Alan C. Mermann, a clinical professor of pediatrics at Yale University and chaplain to the medical school.

Washington voters narrowly defeated a 1991 initiative to legalize physician-assisted suicide.

The 9th U.S. Circuit Court of Appeals also recently upheld a lower court finding that the 19th century stat law barring such aid violates privacy rights guaranteed under the Constitution.

On Monday, the state said it would appeal that ruling to the U.S. Supreme Court.