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Assisted suicides 'often clinically depressed'

08/10/2008

The British Medical Journal has stepped into the debate over whether the law around euthanasia should be changed by publishing research it says proves that a 'death with dignity act' in Britain may be insufficient to protect the vulnerable.

A study published on its website bmj.com reveals as many as one in four terminally ill patients in the State of Oregon in the US, where assisted suicide has been legal since 1997, were clinically depressed when they asked for a help to die.

While there are several safeguards in the act to ensure patients are competent to make the decision to end their life it is also well known that healthcare professionals often fail to recognise depression among the mentally ill.

In 2007, none of the 46 Oregonians who died by lethal ingestion were evaluated by a psychiatrist or a psychologist.

Dr Linda Ganzini and colleagues from Oregon Health and Science University assessed 58 people who were terminally ill and had requested physician assisted suicide or contacted an aid in dying organisation, to determine if they had depression or anxiety. The authors used standardised measures including questionnaires and interviews to assess depression and anxiety in the participants.

The researchers found that the current practice of legalised assistance with dying allowed some potentially ineligible (clinically depressed) patients to receive a lethal prescription.

Fifteen of the participants met the criteria for depression and 13 for anxiety. Forty-two patients had died by the end of the study, 18 received a prescription for a lethal medication under the Act and nine died by lethal ingestion. Fifteen who received a lethal prescription did not meet the criteria for depression, three did, and all three died by lethal ingestion within two months of the research interview.

Although the authors acknowledge that most patients who request aid in dying do not have a depressive disorder they point out that the current practice of death with dignity act may not adequately protect all mentally ill patients and call for increased vigilance and systematic examination for depression among patients who may access legalised aid in dying.