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The Death with Dignity Act was passed by the state in 1997, and there's been intense debate about the extent to which potentially treatable psychiatric disorders may influence a patient's decision to hasten death, according to a news release about the study, published online Oct. 8 by the British Medical Journal.
The act does contain several safeguards to ensure patients are competent to make the decision to end their life, including referral to a psychologist or psychiatrist, if there's concern that a mental illness may be impairing a patient's judgment. However, depression is often overlooked in mentally ill patients.
In 2007, none of the 46 people in Oregon who used physician-assisted suicide were evaluated by a psychologist or psychiatrist, the news release said.
For the new study, researchers at Oregon Health and Sciences University checked for depression or anxiety in 58 terminally ill patients who'd requested physician-assisted suicide or had contacted an assisted death organization. Fifteen of the patients met the criteria for depression and 13 for anxiety.
By the end of the study, 42 patients had died. Of those, 18 received a prescription for a lethal medication, and nine died by lethal ingestion. Of those who received a prescription for a lethal medication, three met the criteria for depression. All three died by lethal ingestion within two months of being assessed by researchers.
While most patients who request physician-assisted suicide do not have a depressive disorder, the study authors suggested that "the current practice of Death with Dignity Act may not adequately protect all mentally ill patients." The authors called for "increased vigilance and systematic examination for depression among patients who may access legalized aid in dying."
While it's important to protect vulnerable patients, it can be difficult to determine if depression is impairing the judgment of terminally ill patients, Dr. Marije van der Lee, of the Helen Dowling Institute in the Netherlands, wrote in an accompanying editorial.
Depression doesn't necessarily impair judgment, van der Lee said. "We should focus on trying to 'protect' patients from becoming depressed in the first place, rather than focus on protecting patients from assisted suicide," she wrote.
-- Robert Preidt
SOURCE: British Medical Journal, news release, Oct. 8, 2008
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