Choosing Assisted Suicide Not for Pain But Depression or Fear of Being a Burden

According to a recent study that interviewed 379 Canadian patients who were receiving palliative care for cancer between 2001 and 2003, over half of those patients (62.8%) believed that assisted suicide should be legalized.

But of the 238 participants in the study who argued that assisted suicide should be legal, only 22 (5.8%) said they would actually exercise the option right away if it were legal, and over half of those 22 said they would do so, not because of heightened levels of pain associated with their illness, but because they felt they were a burden to their family or the health care system.

The study, entitled "Desire for Euthanasia or Physician-Assisted Suicide in Palliative Cancer Care" was published in the most recent issue of Health Psychology, a journal of the APA.

Dr. Keith Wilson, the lead researcher on the study, commented to the Canadian press on the issue of the 22 patients who said they would have chosen assisted suicide were it legal.

"It turns out for those 22 people we're talking about, the issues were much more complicated than pain," said Dr. Wilson. "They didn't tend to have any more pain than the people who didn't want assisted suicide. But they did tend to feel sicker, they did tend to feel weaker. They were more likely to be depressed, and they felt that they had become a burden to others."

Dr. Harvey Chochinov, a palliative care researcher at the University of Manitoba, commented to the Ottawa Citizen on the fact that most of those who desired to end their lives did so because of the fear of being a burden and the associated "profound existential distress."

"To feel a burden to others can mean that someone senses their life serves no ongoing purpose and has no continued sense of meaning," he said.

"That is why palliative care researchers are so interested in this area," he explained, suggesting that palliative care-givers need to explore possible means of eliminating the suffering that sometimes leads a patient to desire suicide. "Finding ways of enhancing or bolstering meaning and purpose could offer one way of addressing suffering seen all too often at the end of life," he said.

While some are already pointing to the consensus amongst the patients interviewed that assisted suicide should be legalized as further evidence that government policy should be altered accordingly, Alex Schadenberg, the executive director of the Euthanasia Prevention Coalition, argues that the study proves the exact opposite. Schadenberg says that current laws that make assisted suicide illegal protect some of society's most vulnerable citizens — those who are approaching the end of their lives — and must therefore be kept in place.

"The Euthanasia Prevent Coalition recognizes that people will sometimes consider euthanasia or assisted suicide when the concept is introduced to them or when they are experiencing ‘profound existential distress,'" said Schadenberg,

"The facts that we need to recognize from this study is that of the 379 palliative care patients who were studied, only 22 seriously considered intentionally dying, and of the 22 people, 12 felt that they were a burden to their family or a drain on health care, 4 felt that assisted suicide was a compassionate choice, 3 expressed a need for autonomy, and the others were either concerned about the possibility of experiencing painful systems in the future or felt that their life was complete already."

He continued, "We know that the legalization of euthanasia and assisted suicide directly threatens the lives of our most vulnerable citizens at the most vulnerable time of their life. We also know that the primary reason people desire ‘mercy killing' is ‘profound existential distress.' Therefore we reiterate that euthanasia and assisted suicide must remain illegal and enforced by the law in order to protect vulnerable people who need to receive excellent care and not killing."

Dr. Wilson also pointed out that the findings of the study he headed demonstrate that in some measure the public's view of assisted suicide is an oversimplified one that fails to take into consideration numerous complex factors.

"The attitudes of the terminally ill may be not so different from the attitudes of the general community," said Wilson, pointing to the fact that the percentage of those participants in the study who would like to see assisted suicide made legal approximately corresponds with the results of some surveys that have asked the same question of the public. "In the mind of the general public, euthanasia and assisted suicide are intricately tied up with the relief of uncontrollable pain. The reality is the circumstances are much more complicated than that. They are partly mental health issues, partly social concerns and pain is only a small part of it."

"The reality is most pain, not all, but most pain, tends to be controllable and that it's a more complex set of factors that are contributing to euthanasia requests than just pain."

Currently there is a concerted push amongst certain activists in Canada to see assisted suicide legalized. Quebec MP Francine Lalonde introduced a bill to legalize euthanasia in 2005; that bill died when an election was called. After being re-elected to office, however, Lalonde promised to reintroduce the bill.

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