Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer

Context Understanding why some terminally ill patients desire a hastened de ath has become an important issue in palliative care and the debate regardi ng legalization of assisted suicide. Objectives To assess the prevalence of desire for hastened death among term inally ill cancer patients and to identify factors corresponding to desire for hastened death. Design Prospective survey conducted in a 200-bed pallia tive care hospital in New York, NY. Patients Ninety-two terminally ill cancer patients (60% female; 70% white; mean age, 65.9 years) admitted between June 1998 and January 1999 for end-o f-life care who passed a cognitive screening test and provided sufficient d ata to permit analysis. Main Outcome Measure Scores on the Schedule of Attitudes Toward Hastened De ath (SAHD), a self-report measure assessing desire for hastened death among individuals with life-threatening medical illness. Results Sixteen patients (17%) were classified as having a high desire for hastened death based on the SAHD and 15 (16%) of 89 patients met criteria f or a current major depressive episode. Desire for hastened death was signif icantly associated with a clinical diagnosis of depression (P =.001) as wel l as with measures of depressive symptom severity (P<.001) and hopelessness (P<.001), In multivariate analyses, depression (P=.003) and hopelessness ( P<.001) provided independent and unique contributions to the prediction of desire for hastened death, while social support (P=.05) and physical functi oning (P=.02) added significant but smaller contributions. Conclusions Desire for hastened death among terminally ill cancer patients is not uncommon. Depression and hopelessness are the strongest predictors o f desire for hastened death in this population and provide independent and unique contributions. Interventions addressing depression, hopelessness, an d social support appear to be important aspects of adequate palliative care , particularly as it relates to desire for hastened death.