Terminally ill think of suicide, but few actually do it, study finds

By Michele Dula Baum
CNN.com Health and Food Writer

(CNN) -- Although many people who face painful, disabling terminal illness may consider actively ending their lives, few really try, a new study on euthanasia and physician-assisted suicide suggests.

"They were very low numbers -- actually, lower than I anticipated," said Dr. Ezekiel Emanuel, an oncologist who is chairman of clinical bioethics at the National Institutes of Health's Magnuson Clinical Center. "Considering the scope of the debate, you would think this was a major, common occurrence."

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In 1996 and 1997, Emanuel and colleagues surveyed 988 terminally ill patients and their caregivers on their attitudes concerning euthanasia and physician-assisted suicide. Interviews were conducted in Worcester, Massachusetts; St. Louis, Missouri; Tucson, Arizona; Birmingham, Alabama; Brooklyn, New York; and Mesa County, Colorado. Results of the study are being reported in this week's Journal of the American Medical Association.

Of those surveyed, 60 percent could agree to the possibility of life-ending actions in the abstract, but just under 11 percent said they had considered it for themselves. Only two patients actually tried, and a third repeatedly asked to be helped to die, but her physician and family members refused.

"I think what this shows is that even in the midst of the debate, it is largely irrelevant," said Emanuel. "It's not the sum and substance of improving end-of-life care."

What researchers also found was a distinct correlation between depression, increased caregiving needs and patients' fears of becoming a burden and serious thoughts of suicide.

"Depression and psychological distress are key motivating factors," Emanuel noted. "We need a better system of taking care of these needs, and of reducing care needs so everything doesn't fall exclusively on the patients' families."

In general, patients less likely to consider euthanasia or physician-assisted suicide were those who were African-American, over 65 and religious, and those who felt appreciated.

"This suggests that when physicians are confronted by a patient's request for euthanasia or physician-assisted suicide, they should attend to the possibility of depression or other psychological stressors," the study authors wrote.

Depression "is something we know about," Emanuel added in a telephone interview. "We need to diagnose it more."

There also are support systems for families, including home health care and hospice services. Still, such services "need to work better," said Emanuel, who has been studying end-of-life issues for the past 15 years. Many of those years have been devoted to the study of euthanasia and physician-assisted suicide, he added.

"I try to understand their experience at the end of life," he said.

Over time, about half the people who initially said they would consider ending their own lives changed their minds. But an equal number who originally rejected the idea also began to think about it more seriously, the oncologist said.

Even when patients were willing to consider suicide and their caregivers thought the possibility was ethical, however, less than 18 percent of caregivers said they would actively participate in helping a loved one to die.

"This may reflect anxiety about prosecution and uncertainty about committing these actions reliably," the study said. "It may also reflect the emotional burden of actually performing euthanasia or assisting with suicide."

Another key finding of Emanuel's study is that some patients fear the possibility of euthanasia or physician-assisted suicide being used against their wishes.

"For some, it's a reassurance, but for others, it's a threat," he said. "We need to acknowledge both."

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Journal of the American Medical Association
National Institutes of Health: Magnuson Clinical Center
The Hemlock Society
Hospice Association of America

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