Attitudes and desires related to euthanasia and physician-assisted suicideamong terminally ill patients and their caregivers

Context Euthanasia and physician-assisted suicide (PAS) are highly controve rsial is' sues. While there are studies of seriously ill patients' interest in euthanasia and PAS, there are no data on the attitudes and desires of t erminally ill patients regarding these issues. Objective To determine the attitudes of terminally ill patients toward euth anasia and PAS, whether they seriously were considering euthanasia and PAS for themselves, the stability of their desires, factors associated with the ir desires, and the proportion of patients who die from these interventions . Design Prospective cohort of terminally ill patients and their primary care givers surveyed twice between March 1996 and July 1997. Setting Outpatient settings in 5 randomly selected metropolitan statistical areas and 1 rural county. Participants A total of 988 patients identified by their physicians to be t erminally ill with any disease except for human immunodeficiency virus infe ction (response ratel 87.4%) and 893 patient-designated primary caregivers (response rate, 97.6%). Main Outcome Measures Support for euthanasia or PAS in standard scenarios; patient-expressed considerations and discussions of their desire for euthan asia or PAS; hoarding of drugs for suicide; patient death by euthanasia or PAS; and patient-reported sociodemographic factors and symptoms related to these outcomes. Results Of the 988 terminally ill patients, a total of 60.2% supported euth anasia or PAS in a hypothetical situation, but only 10.6% reported seriousl y considering euthanasia or PAS for themselves. Factors associated with bei ng less likely to consider euthanasia or PAS were feeling appreciated (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.52-0.82), being aged 65 years or older (OR, 0.52; 95% CI, 0.34-0.82), and being African American (O R, 0.39; 95 % CI, 0.18-0.84). Factors associated with being more likely to consider euthanasia or PAS were depressive symptoms (OR, 1.25; 95 % Clr 1.0 5-1.49), substantial caregiving needs (OR, 1.09; 95 % CI, 1.01 - 1.17), and pain (OR, 1.26; 95% CI, 1.02-1.56). At the follow-up interview, half of th e terminally ill patients who had considered euthanasia or PAS for themselv es changed their minds, while an almost equal number began considering thes e interventions. Patients with depressive symptoms (OR, 5.29; 95% CI, 1.21- 23.2) and dyspnea (OR, 1.68; 95% CI, 1.26-2.22) were more likely to change their minds to consider euthanasia or PAS. According to the caregivers of t he 256 decedents, 14 patients (5.6%) had discussed asking the physician for euthanasia or PAS and 6 (2.5%) had hoarded drugs. Ultimately, of the 256 d ecedents 1 (0.4%) died by euthanasia or PAS, 1 unsuccessfully attempted sui cide, and 1 repeatedly requested for her life to be ended but the family an d physicians refused. Conclusions In this survey, a small proportion of terminally ill patients s eriously considered euthanasia or PAS for themselves. Over a few months, ha lf the patients changed their minds. Patients with depressive symptoms were more likely to change their minds;about desiring euthanasia or PAS.