For years euthanasia advocates have argued that killing a terminally ill patient is morally justified when the patient suffers intolerable pain. Letting a patient suffer in pain is wrong and so hastening death through a lethal dosage of drugs is the only humane and compassionate form of treatment, they reason. Many people believe them.
New research proves them wrong. Depression, not pain, is the real reason that a patient requests death.
Dr. Linda Ganzini, director of geriatric psychiatry at the Veteran's Affairs Medical Center in Portland, Oregon writes, "[S]tudies of dying cancer patients reveal that between 59-100% of patients wanting hastened death have major depressive disorders. Depressed people often focus on the worst possible outcomes and are impaired by apathy, pessimism, and low self-esteem. The experience of palliative care psychiatrists is that depression treatment is effective in terminally ill patients."
A study published in the Journal of the American Medical Association (JAMA) revealed that depression and a feeling of not being appreciated were two consistent factors associated with planning a death. In contrast, the majority (89%) of terminally ill patients who did not personally consider assisted death was less likely to have symptoms of depression and more likely to feel wanted.
More than half of the patients who expressed a desire to die later changed their mind. Others who had not considered any assisted death procedure considered it only after the initial interview. "Depressive symptoms are associated with this instability," researchers wrote. "[W]hen physicians are confronted by a patient's request for euthanasia or physician assisted suicide (PAS), they should attend to the possibility of depression and other psychological stressors."
Why has this research emerged only recently? One reason is the poor record of treating depression as a larger part of palliative care in Holland and Oregon, the only jurisdictions that allow euthanasia or PAS. In Holland, only 3% of all patients who died through assisted death received mental health evaluations. In Oregon, only 15 out of 43 patients were referred for evaluation before receiving their lethal prescriptions.
If treatment for depression becomes part of palliative care, the requests for assisted death will diminish and may even disappear. This isn't lost on euthanasia guru Derek Humphrey who writes: "[W]e should not let academics...make a reputation out of trumpeting that hastened death is no longer necessary as long as there is palliative care, and groups like Hemlock are now superfluous. They apparently give little or no consideration to quality of life, which is uppermost in our minds."
Humphrey's ideology is clear. Social engineering - not the compassionate care of terminally ill patients - drives the euthanasia advocate.
Jack Kervorkian was no different. Autopsies performed on over half (69) of the 130 estimated deaths that Kervorkian assisted revealed that only one quarter of his patients had a terminal condition (meaning they had six months or less to live), over three-fourths experienced a decline in health relatively recently, and most of the 69 were either divorced, widowed, or never married. Thirty five percent were experiencing pain and 13% exhibited overt signs of depression.
Dr. Donna Cohen, coauthor of the study examining Kervorkian's victims writes: "Kervorkian attracted a group of people who were desperate and depressed and didn't have the support systems to deal with their sufferings." "The issue isn't about the right for someone to die. It's about standard's...that create safeguards for people not getting proper care, support, and counseling. "We can do better as a society than to just kill people," she added.
"This is a catastrophe," added Dr. L.J. Dragovic, chief medical examiner of Oakland County, Michigan and coauthor of the study. "Five of those individuals died in vain because they were led to believe that death was the only solution for their problems.
Once the facts about depression are understood, the popular attitudes towards assisted death begin to shift. For example, between 1994 and 1998, support among American oncologists for physician assisted suicide declined more than 50% and support for euthanasia plummeted almost 75% according to a survey published in the Annals of Internal Medicine. Researchers found that better training in end of life care and greater accessibility to end of life treatment technologies contributed to this decline.
Defenders of the sanctity of life have two tasks. The first is to provide support, comfort, and help to those we know who suffer with a terminal disease. Depression can be alleviated. Hope can be restored by spouses, children, friends, clergy, and others.
The second is to expose the fallacy that patients choose assisted death because they suffer from intolerable pain. They don't. Depression, not pain, shapes the patient's decision to die and it can be treated like any other symptom of the disease.
Rev. Johannes L. Jacobse is a priest in the Greek Orthodox Archdiocese of America. © 2002 Rev. Johannes L. Jacobse