Predictors of pursuit of physician-assisted death

Kathryn A. Smith, Theresa A. Harvath, Elizabeth R. Goy, Linda Ganzini

    Research output: Contribution to journalArticle

    20 Citations (Scopus)

    Abstract

    Context Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act. The States of Washington, Montana, Vermont, and New Mexico have since provided legal sanction for PAD. Through 2013, 1173 Oregonians have received a prescription under the Death with Dignity Act and 752 have died after taking the prescribed medication in Oregon. Objectives To determine the predictive value of personal and interpersonal variables in the pursuit of PAD. Methods Fifty-five Oregonians who either requested PAD or contacted a PAD advocacy organization were compared with 39 individuals with advanced disease who did not pursue PAD. We compared the two groups on responses to standardized measures of depression, hopelessness, spirituality, social support, and pain. We also compared the two groups on style of attachment to intimate others and caregivers as understood through attachment theory. Results We found that PAD requesters had higher levels of depression, hopelessness, and dismissive attachment (attachment to others characterized by independence and self-reliance), and lower levels of spirituality. There were moderate correlations among the variables of spirituality, hopelessness, depression, social support, and dismissive attachment. There was a strong correlation between depression and hopelessness. Low spirituality emerged as the strongest predictor of pursuit of PAD in the regression analysis. Conclusion Although some factors motivating pursuit of PAD, such as depression, may be ameliorated by medical interventions, other factors, such as style of attachment and sense of spirituality, are long-standing aspects of the individual that should be supported at the end of life. Practitioners must develop respectful awareness and understanding of the interpersonal and spiritual perspectives of their patients to provide such support.

    Original languageEnglish (US)
    Pages (from-to)555-561
    Number of pages7
    JournalJournal of Pain and Symptom Management
    Volume49
    Issue number3
    DOIs
    StatePublished - Mar 1 2015

    Fingerprint

    Assisted Suicide
    Spirituality
    Physicians
    Depression
    Right to Die
    Social Support
    Caregivers
    Prescriptions
    Regression Analysis
    Organizations
    Pain

    Keywords

    • attachment
    • depression
    • end-of-life care
    • euthanasia
    • hopelessness
    • pain
    • Physician-assisted death
    • spirituality

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine
    • Clinical Neurology
    • Nursing(all)
    • Medicine(all)

    Cite this

    Predictors of pursuit of physician-assisted death. / Smith, Kathryn A.; Harvath, Theresa A.; Goy, Elizabeth R.; Ganzini, Linda.

    In: Journal of Pain and Symptom Management, Vol. 49, No. 3, 01.03.2015, p. 555-561.

    Research output: Contribution to journalArticle

    Smith, Kathryn A. ; Harvath, Theresa A. ; Goy, Elizabeth R. ; Ganzini, Linda. / Predictors of pursuit of physician-assisted death. In: Journal of Pain and Symptom Management. 2015 ; Vol. 49, No. 3. pp. 555-561.
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    abstract = "Context Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act. The States of Washington, Montana, Vermont, and New Mexico have since provided legal sanction for PAD. Through 2013, 1173 Oregonians have received a prescription under the Death with Dignity Act and 752 have died after taking the prescribed medication in Oregon. Objectives To determine the predictive value of personal and interpersonal variables in the pursuit of PAD. Methods Fifty-five Oregonians who either requested PAD or contacted a PAD advocacy organization were compared with 39 individuals with advanced disease who did not pursue PAD. We compared the two groups on responses to standardized measures of depression, hopelessness, spirituality, social support, and pain. We also compared the two groups on style of attachment to intimate others and caregivers as understood through attachment theory. Results We found that PAD requesters had higher levels of depression, hopelessness, and dismissive attachment (attachment to others characterized by independence and self-reliance), and lower levels of spirituality. There were moderate correlations among the variables of spirituality, hopelessness, depression, social support, and dismissive attachment. There was a strong correlation between depression and hopelessness. Low spirituality emerged as the strongest predictor of pursuit of PAD in the regression analysis. Conclusion Although some factors motivating pursuit of PAD, such as depression, may be ameliorated by medical interventions, other factors, such as style of attachment and sense of spirituality, are long-standing aspects of the individual that should be supported at the end of life. Practitioners must develop respectful awareness and understanding of the interpersonal and spiritual perspectives of their patients to provide such support.",
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