Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-s even cases of physician-assisted suicides (PAS) of Kevorkian as collected b y means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS pati ents was not typical of the conditions that lead to death in the United Sta tes. 2) Consistent with the above findings, our pilot data indicate that on ly 31.1 percent of these patients were terminal. While 73.9 percent were de scribed as reporting pain, only 42.6 percent were revealed at autopsy to ha ve a specific anatomical basis for their pain. However 36 percent were desc ribed as depressed, 66 percent as having some disability, and perhaps of ke y importance, 90 percent expressed a fear of dependency. Most important, ou r pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suici des in the United States in 1995, resembling instead the approximate patter n for unsuccessful suicide attempts. 4) Approximately 75 percent of both me n and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and thr ee times as likely to be terminal. Our pilot data indicate PAS women are mo re likely to be described as depressed and twice as likely to have had a hi story of previous unsuccessful suicide attempts. 5) Kevorkian's patients we re older than the typical unaided suicides in America. Reported pain decrea ses with age as does depression; however anatomical basis for pain increase s slightly with age, and no age effect emerges for terminality. 6) Approxim ately two-thirds of these physician-assisted suicides were at middle SES le vels. History of disability was the biggest risk factor for the low SES pat ients and fear of dependency for the high SES patients.